台湾地区末期非癌症病患缓和医疗谘询服务之趋势分析：一项 9 年的观察性研究。

Trend analysis of palliative care consultation service for terminally ill non-cancer patients in Taiwan: a 9-year observational study.

机构信息

Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan.

Technology Transfer and Incubation Center, National Health Research Institutes, Miaoli, Taiwan.

出版信息

BMC Palliat Care. 2021 Nov 25;20(1):181. doi: 10.1186/s12904-021-00879-z.

BACKGROUNDS

Early integration of palliative care for terminally ill non-cancer patients improves quality of life. However, there are scanty data on Palliative Care Consultation Service (PCCS) among non-cancer patients.

METHODS

In this 9-year observational study Data were collected from the Hospice-Palliative Clinical Database (HPCD) of Taichung Veterans General Hospital (TCVGH). Terminally ill non-cancer patients with 9 categories of diagnoses who received PCCS during 2011 to 2019 were enrolled. Trend analysis was performed to evaluate differences in categories of diagnosis throughout study period, duration of PCCS, patient outcomes, DNR declaration, awareness of disease by patients and families before and after PCCS.

RESULTS

In total, 536 non-cancer patients received PCCS from 2011 to 2019 with an average age of 70.7 years. The average duration of PCCS was 18.4 days. The distributions of age, gender, patient outcomes, family's awareness of disease before PCCS, and patient's awareness of disease after PCCS were significantly different among the diagnoses. Organic brain disease and Chronic kidney disease (CKD) were the most prevalent diagnoses in patients receiving PCCS in 2019. For DNR declaration, the percentage of patients signing DNR before PCCS remained high throughout the study period (92.8% in 2019). Patient outcomes varied according to the disease diagnoses.

CONCLUSION

This 9-year observational study showed that the trend of PCCS among non-cancer patients had changed over the duration of the study. An increasing number of terminally ill non-cancer patients received PCCS during late life, thereby increasing the awareness of disease for both patients and families, which would tend to better prepare terminally ill patients for end-of-life as they may consider DNR consent. Early integration of PCCS into ordinary care for terminally non-cancer patients is essential for better quality of life.

背景

为终末期非癌症患者提供早期姑息治疗可提高生活质量。然而，关于非癌症患者的姑息治疗咨询服务（PCCS）的数据很少。

方法

本研究为一项 9 年观察性研究，数据来自台中荣民总医院（TCVGH）临终关怀临床数据库（HPCD）。纳入 2011 年至 2019 年期间接受 PCCS 的 9 类诊断的终末期非癌症患者。通过趋势分析评估研究期间诊断类别的差异、PCCS 的持续时间、患者结局、DNR 声明、患者和家庭在 PCCS 前后对疾病的认知。

结果

共有 536 名非癌症患者在 2011 年至 2019 年期间接受 PCCS，平均年龄为 70.7 岁。PCCS 的平均持续时间为 18.4 天。各诊断组的年龄、性别、患者结局、PCCS 前家庭对疾病的认知以及 PCCS 后患者对疾病的认知分布差异均有统计学意义。2019 年，在接受 PCCS 的患者中，最常见的诊断是脑器质性疾病和慢性肾脏病（CKD）。关于 DNR 声明，在整个研究期间，在 PCCS 前签署 DNR 的患者比例一直很高（2019 年为 92.8%）。患者结局因疾病诊断而异。

结论

这项为期 9 年的观察性研究表明，在研究期间，非癌症患者的 PCCS 趋势发生了变化。越来越多的终末期非癌症患者在生命晚期接受 PCCS，从而提高了患者和家庭对疾病的认识，这可能会使终末期患者更好地为生命末期做好准备，因为他们可能会考虑 DNR 同意。将 PCCS 尽早纳入普通护理中，对于提高非癌症患者的生活质量至关重要。