Hansen Maiken Bang Bang, Groenvold Mogens, Adsersen Mathilde, Jensen Henry, Ibfelt Else Helene, Petersen Morten Aagaard, Neergaard Mette Asbjørn, Møller Henrik, Olesen Tina Bech
The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
Department of Cancer and Cancer Screening, The Danish Clinical Quality Program - National Clinical Registries (RKKP), Copenhagen, Denmark.
BMJ Support Palliat Care. 2023 Apr 25. doi: 10.1136/spcare-2023-004324.
Few studies have examined whether access to, and quality of, specialised palliative care changed during the COVID-19 pandemic. This study investigated changes in access to and quality of specialised palliative care during the pandemic in Denmark compared to previously.
An observational study using data from the Danish Palliative Care Database combined with other nationwide registries was conducted, including 69 696 patients referred to palliative care services in Denmark from 2018 to 2022. Study outcomes included number of referrals and admissions to palliative care, and the proportions of patients fulfilling four palliative care quality indicators. The indicators assessed admissions among referred, waiting time from referral to admission, symptom screening using the European Organisation for Research and Treatment of Cancer Quality of Life Questionaire-Core-15-Palliative Care (EORTC QLQ-C15-PAL) questionnaire at admission, and discussion at multidisciplinary conference. Logistic regression analysed whether the probability of fulfilling each indicator differed between the pandemic period and pre-pandemic, while adjusting for possible confounders.
Number of referrals and admissions to specialised palliative care were lower during the pandemic. The odds for being admitted within 10 days of referral was higher during the pandemic (OR: 1.38; 95% CI: 1.32 to 1.45) whereas the odds for answering the EORTC questionnaire (0.88; 95% CI: 0.85 to 0.92) and for being discussed at multidisciplinary conference (0.93; 95% CI: 0.89 to 0.97) were lower compared with pre-pandemic.
Fewer patients were referred to specialised palliative care during the pandemic, and fewer were screened for palliative care needs. In future pandemics or similar scenarios, it is important to pay special attention to referral rates and to maintain the same high level of specialised palliative care.
很少有研究探讨在新冠疫情期间专科姑息治疗的可及性和质量是否发生了变化。本研究调查了丹麦在疫情期间与之前相比专科姑息治疗的可及性和质量的变化。
开展了一项观察性研究，使用丹麦姑息治疗数据库的数据并结合其他全国性登记处的数据，纳入了2018年至2022年期间转介至丹麦姑息治疗服务机构的69696名患者。研究结局包括姑息治疗的转介和入院人数，以及符合四项姑息治疗质量指标的患者比例。这些指标评估了转介患者中的入院情况、从转介到入院的等待时间、入院时使用欧洲癌症研究与治疗组织生活质量问卷核心版-15-姑息治疗（EORTC QLQ-C15-PAL）问卷进行的症状筛查，以及在多学科会议上的讨论情况。逻辑回归分析了在调整可能的混杂因素后，疫情期间和疫情前符合各指标的概率是否存在差异。
疫情期间专科姑息治疗的转介和入院人数较低。在疫情期间，转介后10天内入院的几率更高（比值比：1.38；95%置信区间：1.32至1.45），而与疫情前相比，回答EORTC问卷的几率（0.88；95%置信区间：0.85至0.92）和在多学科会议上被讨论的几率（0.93；95%置信区间：0.89至0.97）较低。
疫情期间转介至专科姑息治疗的患者较少，接受姑息治疗需求筛查的患者也较少。在未来的疫情或类似情况下，重视转介率并维持同样高水平的专科姑息治疗非常重要。
