长期机械通气和护理人员负担：家庭与长期护理机构。

Prolonged mechanical ventilation and caregiver strain: Home vs. long-term care facility.

机构信息

Chronic Ventilator-Dependent Division, Herzog Medical Center, Jerusalem, Israel.

Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.

出版信息

Palliat Support Care. 2023 Jun;21(3):429-437. doi: 10.1017/S147895152200027X.

DOI:10.1017/S147895152200027X

PMID:35266449

Abstract

OBJECTIVE

The number of patients treated with prolonged mechanical ventilation (PMV) is steadily rising. Traditionally treated within specialized long-term care facilities (LTCFs), healthcare providers are increasingly promoting homecare as a technologically safe, humane, and cheaper alternative. Little is known concerning their informal caregivers (ICGs), despite their crucial role in facilitating care. This study examines caregiver strain among the primary ICG of PMV patients treated at home vs. LTCF.

METHOD

This study was an observational cross-sectional study. The study enrolled 120/123 PMV patients ≥18 years within the study region (46 treated with homecare/74 treated at the LTCF) and 106 ICGs (34 ICGs/46 homecare patients and 72 ICGs/74 LTCF patients). Caregiver assessment included the 13-item Modified Caregiver Strain Index (Mod CSI) (0-26 maximum); patient assessment included symptom burden (the revised Edmonton Symptom Assessment System).

RESULTS

The mean age of ICGs was 58.9 years old; 60.4% were females; 82.1% were married; 29.2% were patient's spouses; and 40.6% were patient's children. The total Mod CSI was 13.58 (SD 6.52) and similar between home vs. LTCF (14.30 SD 7.50 vs. 13.26 SD 6.03, = 0.50), or communicative vs. non-communicative patients (13.50 SD 7.12 vs. 13.64 SD 6.04, = 0.93). Hierarchical analysis identified three clusters of caregiver strain, with ICGs at home vs. LTCF reporting significantly lower mood strain, higher burden, and similar levels of lifestyle disturbance. In adjusted models, homecare was significantly associated with reduced mood strain and increased burden, while increased patient symptomatology was significantly associated with total strain, mood, and burden strain clusters.

SIGNIFICANCE OF RESULTS

Recognizing the different patterns of caregiver strain at home or LTCF is a prerequisite for addressing their palliative care needs and improving the wellbeing and resilience of informal caregivers, who often play a critical role in deciding whether to treat the PMV patient at home or LTCF.

摘要

目的

接受长时间机械通气（PMV）治疗的患者数量正在稳步上升。这些患者传统上在专门的长期护理机构（LTCF）中接受治疗，而医疗保健提供者越来越多地提倡家庭护理作为一种技术上安全、人道且更便宜的替代方案。尽管他们在促进护理方面发挥着至关重要的作用，但对于他们的非正式照顾者（ICG）却知之甚少。这项研究调查了在家中接受 PMV 治疗的患者的主要 ICG 与在 LTCF 中接受治疗的患者的 caregiver 压力。

方法

这是一项观察性的横断面研究。该研究在研究区域内招募了 123 名年龄在 18 岁及以上的 PMV 患者（46 名接受家庭护理/74 名接受 LTCF 治疗）和 106 名 ICG（34 名 ICG/46 名家庭护理患者和 72 名 ICG/74 名 LTCF 患者）。对照顾者的评估包括 13 项改良照顾者压力指数（Mod CSI）（0-26 分）；对患者的评估包括症状负担（修订后的爱丁堡症状评估系统）。

结果

ICG 的平均年龄为 58.9 岁；60.4%为女性；82.1%已婚；29.2%为患者的配偶；40.6%为患者的子女。总 Mod CSI 为 13.58（SD 6.52），家庭与 LTCF 之间无差异（14.30 SD 7.50 与 13.26 SD 6.03， = 0.50），或有沟通能力与无沟通能力的患者之间无差异（13.50 SD 7.12 与 13.64 SD 6.04， = 0.93）。层次分析确定了三个 caregiver 压力群，家庭与 LTCF 的 ICG 报告情绪压力显著降低，负担增加，而生活方式干扰程度相似。在调整后的模型中，家庭护理与情绪压力减轻和负担增加显著相关，而患者症状增加与总压力、情绪和负担压力群显著相关。