Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore.
Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
Ann Surg Oncol. 2023 Dec;30(13):8054-8060. doi: 10.1245/s10434-023-14190-z. Epub 2023 Sep 6.
BACKGROUND: Palliative surgical oncology patients represent a unique group with complex needs who often require multidisciplinary input for the provision of timely and holistic care. The authors assembled a multi-disciplinary palliative intervention team and evaluated its association with the quality of discussions on goals of care (GOC) among advanced cancer patients undergoing palliative interventions. METHODS: This prospective cohort study analyzed advanced cancer patients undergoing palliative interventions at a single urban academic center from October 2019 to March 2022. In January 2021, a multi-disciplinary palliative surgical intervention (MD-PALS) team was assembled. All palliative surgical oncology patients were discussed at multi-disciplinary meetings and managed by members of the MD-PALS team. An interrupted time series (ITS) model was built to evaluate the association of MD-PALS implementation and the quality of GOC discussions as measured by a consensus-derived four-point GOC discussion quality score. RESULTS: The study recruited 126 palliative surgical oncology patients: 44 in the pre-MD-PALS group and 82 in the post-MD-PALS group. The two groups did not differ significantly in baseline demographics, treatment, or postoperative and survival outcomes. Compared with the pre-MD-PALS group, the post-MD-PALS group had a significantly higher mean GOC discussion quality score (1.34 vs 2.61; p < 0.001). Based on the ITS model, the average quarterly GOC discussion quality score increased significantly among patients after implementation of the MD-PALS team (change = 1.93; 95 % confidence interval, 0.96-2.90; P = 0.003). CONCLUSION: The implementation of an MD-PALS team was associated with improvements in the quality of GOC discussions among palliative surgical oncology patients.
背景:姑息性外科肿瘤患者是一个具有复杂需求的独特群体,他们通常需要多学科的介入,以提供及时和全面的护理。作者组建了一个多学科姑息干预团队,并评估了其与接受姑息性干预的晚期癌症患者的目标关怀(GOC)讨论质量之间的关联。
方法:本前瞻性队列研究分析了 2019 年 10 月至 2022 年 3 月在一家单中心城市学术中心接受姑息性干预的晚期癌症患者。2021 年 1 月,组建了一个多学科姑息性外科干预(MD-PALS)团队。所有姑息性外科肿瘤患者都在多学科会议上进行讨论,并由 MD-PALS 团队成员进行管理。建立了一个中断时间序列(ITS)模型,以评估 MD-PALS 实施与 GOC 讨论质量的关联,该质量通过共识衍生的四点 GOC 讨论质量评分来衡量。
结果:本研究共纳入 126 例姑息性外科肿瘤患者:MD-PALS 前组 44 例,MD-PALS 后组 82 例。两组在基线人口统计学、治疗和术后及生存结果方面无显著差异。与 MD-PALS 前组相比,MD-PALS 后组的 GOC 讨论质量评分明显更高(1.34 对 2.61;p<0.001)。基于 ITS 模型,在实施 MD-PALS 团队后,患者的平均季度 GOC 讨论质量评分显著提高(变化=1.93;95%置信区间,0.96-2.90;P=0.003)。
结论:多学科姑息干预团队的实施与姑息性外科肿瘤患者的 GOC 讨论质量的提高有关。
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