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多学科团队的实施与姑息性外科肿瘤患者的目标关怀质量讨论。

Implementation of a Multi-Disciplinary Team and Quality of Goals of Care Discussions in Palliative Surgical Oncology Patients.

机构信息

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.

出版信息

Ann Surg Oncol. 2023 Dec;30(13):8054-8060. doi: 10.1245/s10434-023-14190-z. Epub 2023 Sep 6.


DOI:10.1245/s10434-023-14190-z
PMID:37672144
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10625938/
Abstract

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.

摘要

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。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d169/10625938/f7e77cc36b62/10434_2023_14190_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d169/10625938/f7e77cc36b62/10434_2023_14190_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d169/10625938/f7e77cc36b62/10434_2023_14190_Fig1_HTML.jpg

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引用本文的文献

[1]
Effect of multidisciplinary team-style continuity of care and nutritional nursing on lung cancer: randomized study.

Future Oncol. 2024

[2]
Knowledge and thresholds for palliative care and surgery among healthcare providers caring for adults with serious illness.

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[3]
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[4]
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本文引用的文献

[1]
Trajectories of Patient-Reported Outcomes After Palliative Gastrointestinal Surgery in Advanced Cancer: Is Good Quality of Life Sustainable?

Ann Surg Open. 2022-9-26

[2]
Use of Palliative Interventions at End of Life for Advanced Gastrointestinal Cancer.

Ann Surg Oncol. 2022-11

[3]
Managing critical care during COVID-19 pandemic: The experience of an ICU of a tertiary care hospital.

J Infect Public Health. 2021-11

[4]
Natural Language Processing to Identify Advance Care Planning Documentation in a Multisite Pragmatic Clinical Trial.

J Pain Symptom Manage. 2022-1

[5]
Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries.

CA Cancer J Clin. 2021-5

[6]
COVID-19 and surgery: A thematic analysis of unintended consequences on performance, practice and surgical training.

Surgeon. 2021-2

[7]
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Ann Surg. 2022-1-1

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Changes in Interventional Radiology Practice in a Tertiary Academic Center in the United States During the Coronavirus Disease 2019 (COVID-19) Pandemic.

J Am Coll Radiol. 2020-7

[9]
Redesigning a Department of Surgery during the COVID-19 Pandemic.

J Gastrointest Surg. 2020-4-28

[10]
Effect of early and systematic integration of palliative care in patients with advanced cancer: a randomised controlled trial.

Lancet Oncol. 2018-2-3

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