School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia.
Southern Adelaide Palliative Services, Southern Adelaide Local Health Network and Flinders University, South Australia, Australia.
J Palliat Med. 2024 Jul;27(7):905-911. doi: 10.1089/jpm.2023.0537. Epub 2024 Mar 12.
Sleep disturbances, including insomnia, sleep-disordered breathing, and circadian rhythm disorders with potential consequences including excessive daytime somnolence and worsening fatigue, are prevalent yet largely under-measured and therefore under-managed problems in people receiving palliative care. This has the potential to negatively affect the person's functioning and quality of life. We aimed to review the current practice of assessment and management of sleep disturbances in people with life-limiting illnesses in Australian and New Zealand palliative care settings, and to define areas for improvement in assessment and management of sleep disturbances and further research. A cross-sectional, online survey was conducted with palliative care health professionals (PCHPs) to explore current approaches to routine assessment of sleep disturbances and PCHPs' awareness of, and perceived access to, evidence-based resources for assessing and managing sleep disturbances in their local settings. Fifty-four PCHPs responded to the survey, including allied health professionals (44%), palliative care nurses (26%), and physicians (19%). Over 70% of PCHPs endorsed routine verbal screening of sleep symptoms, and >90% recommended management with basic behavioral strategies. However, none of PCHPs used validated patient-reported outcome measures for sleep, and <10% of PCHPs demonstrated awareness or use of sleep-specific interventions (including medications). Only 40% reported they had access to sleep specialist services for patients. Our findings provide a useful snapshot of current approaches to managing sleep disturbances in palliative care. Gaps in current practice are highlighted, including the lack of structured, clinical assessment, referral pathways, and PCHPs' perceived lack of access to targeted interventions for sleep disturbances.
睡眠障碍，包括失眠、睡眠呼吸障碍和昼夜节律紊乱，可能导致白天过度嗜睡和疲劳加重等后果，在接受姑息治疗的人群中普遍存在，但很大程度上未得到充分测量和管理。这可能会对患者的功能和生活质量产生负面影响。我们旨在审查澳大利亚和新西兰姑息治疗环境中患有生命有限疾病的人群中睡眠障碍的评估和管理现状，并确定在评估和管理睡眠障碍以及进一步研究方面需要改进的领域。我们对姑息治疗卫生专业人员（PCHP）进行了横断面、在线调查，以探讨他们对常规评估睡眠障碍的方法，以及他们对当地环境中评估和管理睡眠障碍的循证资源的了解和可及性。54 名 PCHP 对调查做出了回应，包括联合健康专业人员（44%）、姑息治疗护士（26%）和医生（19%）。超过 70%的 PCHP 认可对睡眠症状进行常规口头筛查，超过 90%的人建议使用基本的行为策略进行管理。然而，没有 PCHP 使用经过验证的患者报告的睡眠结局测量工具，不到 10%的 PCHP 表现出对睡眠特异性干预（包括药物）的认识或使用。只有 40%的人报告说他们可以为患者获得睡眠专家服务。我们的研究结果提供了姑息治疗中管理睡眠障碍的当前方法的有用快照。突出了当前实践中的差距，包括缺乏结构化的临床评估、转诊途径，以及 PCHP 对睡眠障碍针对性干预措施的感知缺乏。
