Research Group Medical Ethics, Philipps-University Marburg, Marburg, Germany.
Department of Medical Oncology and Palliative Care, University Hospital of Giessen and Marburg, Giessen Site, Germany.
Am J Hosp Palliat Care. 2023 Aug;40(8):829-836. doi: 10.1177/10499091221140075. Epub 2022 Nov 17.
There is a research gap regarding safety concerns of patients at the end of life. The aim of this study was, therefore, to explore whether patients under specialist community palliative care feel safe at home and which factors affect the perceived safety. Furthermore, we investigated if perception of safety is associated with different aspects of subsequent care.
Using a standardized questionnaire, a cross-sectional survey was conducted among 100 specialist community palliative care patients. Logistic regression was used to examine the strength of the association between clinical and socio-demographic variables and the perception of safety. After a 6-month follow-up period, we analyzed differences in various care-related outcomes between patients with unaffected and impaired perceptions of safety.
In our study, one in five patients receiving specialist community palliative care expressed safety concerns. Subdomains of safety that were reported most frequently were physical disability (60%), physical symptoms (30%), psychological symptoms (26%), and side effects/complications of drug therapy (19%). Of the participants surveyed after the initial COVID-19 lockdown, 35.1% reported that they felt their safety had been adversely affected by the pandemic. Compromised safety perception was associated with higher levels of palliative care-related problems, and proximity to death.
Our study uncovered relevant safety concerns of palliative care patients receiving specialist community palliative care. The insights gained into patient-reported problems may help healthcare professionals to identify situations where patients feel unsafe. Further research should address primary and secondary prevention measures to improve the quality of end-of-life care in the home environment.
在生命末期患者的安全问题方面存在研究空白。因此，本研究旨在探讨接受专科社区姑息治疗的患者在家中是否感到安全，以及哪些因素影响其感知的安全性。此外，我们还调查了感知安全性是否与后续护理的不同方面相关。
使用标准化问卷，对 100 名接受专科社区姑息治疗的患者进行了横断面调查。使用逻辑回归分析检查临床和社会人口统计学变量与感知安全性之间的关联强度。在 6 个月的随访期后，我们分析了感知安全性不受影响和受损的患者在各种护理相关结局方面的差异。
在我们的研究中，五分之一接受专科社区姑息治疗的患者表达了安全问题。报告的安全问题的子领域包括身体残疾（60%）、身体症状（30%）、心理症状（26%）和药物治疗的副作用/并发症（19%）。在最初的 COVID-19 封锁后接受调查的参与者中，35.1%表示他们感到自己的安全受到了大流行的不利影响。感知安全性受损与更高水平的姑息治疗相关问题以及接近死亡有关。
我们的研究揭示了接受专科社区姑息治疗的姑息治疗患者的相关安全问题。对患者报告问题的深入了解可能有助于医疗保健专业人员识别患者感到不安全的情况。进一步的研究应针对初级和二级预防措施，以提高家庭环境中临终关怀的质量。
