Chen Juan, Huan Jingjing, Chen Chunyan, Xu Wenxia, Jia Aiqun
Department of Emergency, The People's Hospital of Rugao Nantong 226500, Jiangsu, China.
Department of Oncology, The People's Hospital of Rugao Nantong 226500, Jiangsu, China.
Am J Cancer Res. 2024 May 15;14(5):2478-2492. doi: 10.62347/TRQO1589. eCollection 2024.
To assesses the impact of integrating hospice care with psychological interventions on patient well-being and to introduce a predictive nomogram model for delirium that incorporates clinical and psychosocial variables, thereby improving the accuracy in hospice care environments. Data from 381 patients treated from September 2018 to February 2023 were analyzed. The patients were divided into a control group (n=177, receiving standard care) and an experimental group (n=204, receiving combined hospice care and psychological interventions) according to the treatment modality. The duration of care extended until the patient's discharge from the hospital or death. The experimental group demonstrated significant improvements in emotional well-being and a lower incidence of delirium compared to the control group. Specifically, emotional well-being assessments revealed marked improvements in the experimental group, as evidenced by lower scores on the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) post-intervention. The nomogram model, developed using logistic regression based on clinical characteristics, effectively predicted the risk of delirium in patients with advanced cancer. Significant predictors in the model included ECOG score ≥3, Palliative Prognostic Index score ≥6, opioid usage, polypharmacy, infections, sleep disorders, organ failure, brain metastases, electrolyte imbalances, activity limitations, pre-care SAS score ≥60, pre-care SDS score ≥63, and pre-care KPS score ≥60. The model's predictive accuracy was validated, showing AUC values of 0.839 for the training cohort and 0.864 for the validation cohort, with calibration and Decision Curve Analysis (DCA) confirming its clinical utility. Integrating hospice care with psychological interventions not only significantly enhanced the emotional well-being of advanced cancer patients but also reduced the actual incidence of delirium. This approach, offering a valuable Nomogram model for precise care planning and risk management, underscores the importance of integrated, personalized care strategies in advanced cancer management.
评估临终关怀与心理干预相结合对患者幸福感的影响，并引入一种包含临床和社会心理变量的谵妄预测列线图模型，从而提高临终关怀环境中的准确性。分析了2018年9月至2023年2月期间接受治疗的381例患者的数据。根据治疗方式，将患者分为对照组（n = 177，接受标准护理）和实验组（n = 204，接受临终关怀与心理干预相结合的护理）。护理持续时间延长至患者出院或死亡。与对照组相比，实验组在情绪幸福感方面有显著改善，谵妄发生率更低。具体而言，情绪幸福感评估显示实验组有显著改善，干预后自评焦虑量表（SAS）和自评抑郁量表（SDS）得分降低证明了这一点。基于临床特征使用逻辑回归开发的列线图模型有效地预测了晚期癌症患者发生谵妄的风险。该模型中的显著预测因素包括东部肿瘤协作组（ECOG）评分≥3、姑息预后指数（Palliative Prognostic Index）评分≥6、阿片类药物使用、多种药物联用、感染、睡眠障碍、器官衰竭、脑转移、电解质失衡、活动受限、护理前SAS评分≥60、护理前SDS评分≥63以及护理前Karnofsky功能状态评分（KPS）≥60。该模型的预测准确性得到验证，训练队列的曲线下面积（AUC）值为0.839，验证队列的AUC值为0.864，校准和决策曲线分析（DCA）证实了其临床实用性。将临终关怀与心理干预相结合不仅显著提高了晚期癌症患者的情绪幸福感，还降低了谵妄的实际发生率。这种方法为精确的护理计划和风险管理提供了有价值的列线图模型，强调了综合、个性化护理策略在晚期癌症管理中的重要性。
