中国三级综合医院和肿瘤医院开展肿瘤姑息治疗服务的全国性调查。

National survey on the availability of oncology palliative care services at tertiary general and cancer hospitals in China.

机构信息

Department of Geriatric Medicine, The Second Medical Center, Chinese PLA General Hospital, Haidian District, 28Th, Fuxing Road, Beijing, 100853, People's Republic of China.

Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

出版信息

BMC Palliat Care. 2023 Sep 28;22(1):144. doi: 10.1186/s12904-023-01259-5.

DOI:10.1186/s12904-023-01259-5

PMID:37770965

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10536755/

Abstract

BACKGROUND

This nationwide survey studied the level of palliative care (PC) access for Chinese patients with cancer among cancer care providers either in tertiary general hospitals or cancer hospitals in China.

METHODS

Using a probability-proportionate-to-size method, we identified local tertiary general hospitals with oncology departments to match cancer hospitals at the same geographic area. A PC program leader or a designee at each hospital reported available PC services, including staffing, inpatient and outpatient services, education, and research, with most questions adapted from a previous national survey on PC. The primary outcome was availability of a PC service.

RESULTS

Most responders reported that some type of PC service (possibly called "comprehensive cancer care," "pain and symptom management," or "supportive care") was available at their institution (84.3% of tertiary general hospitals, 82.8% of cancer hospitals). However, cancer hospitals were significantly more likely than tertiary general hospitals to have a PC department or specialist (34.1% vs. 15.5%, p < 0.001). The most popular services were pain consultation (> 92%), symptom management (> 77%), comprehensive care plans (~ 60%), obtaining advanced directives and do-not-resuscitate orders (~ 45%), referrals to hospice (> 32%), and psychiatric assessment (> 25%). Cancer hospitals were also more likely than tertiary general hospitals to report having inpatient beds for PC (46.3% vs. 30.5%; p = 0.010), outpatient PC clinics (28.0% vs. 16.8%; p = 0.029), educational programs (18.2% vs. 9.0%, p = 0.014), and research programs (17.2% vs. 9.3%, p < 0.001).

CONCLUSIONS

Cancer hospitals are more likely to offer PC than are tertiary general hospitals in China. Our findings highlight opportunities to further increase the PC capacity in Chinese hospitals.

摘要

背景

本项全国性调查研究了中国癌症专科医院和三级综合医院的癌症医护人员为癌症患者提供姑息治疗（PC）的水平。

方法

采用概率比例匹配法，我们确定了当地的有肿瘤科室的三级综合医院，使其与同一地理区域的癌症医院相匹配。每家医院的 PC 项目负责人或指定人员报告了可用的 PC 服务，包括人员配备、住院和门诊服务、教育和研究，其中大部分问题均改编自之前的一项姑息治疗全国性调查。主要结果是提供 PC 服务的情况。

结果

大多数应答者报告称，其所在机构提供某种类型的 PC 服务（可能称为“综合癌症护理”、“疼痛和症状管理”或“支持性护理”）（三级综合医院 84.3%，癌症医院 82.8%）。然而，癌症医院拥有 PC 部门或专家的比例明显高于三级综合医院（34.1%比 15.5%，p<0.001）。最受欢迎的服务是疼痛咨询（>92%）、症状管理（>77%）、综合护理计划（~~60%）、获取预先指示和不复苏医嘱（~~45%）、转介至临终关怀（>32%）和精神科评估（>25%）。与三级综合医院相比，癌症医院更有可能报告拥有 PC 住院病床（46.3%比 30.5%；p=0.010）、PC 门诊（28.0%比 16.8%；p=0.029）、教育项目（18.2%比 9.0%；p=0.014）和研究项目（17.2%比 9.3%；p<0.001）。