Department of Nursing, Taipei City Hospital, Taipei City, Taiwan.
College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan.
Front Public Health. 2024 Jul 25;12:1411185. doi: 10.3389/fpubh.2024.1411185. eCollection 2024.
BACKGROUND: Prevention measures for palliative care and the provision of discharge planning services for inpatients in Taiwan before and during the COVID-19 pandemic had not been investigated. This study was aimed to investigate the factors associated with heightened palliative care needs and increased mortality rates. METHODS: This research adopts a retrospective case-control study design. The investigation encompasses patients admitted before the pandemic (from January 1, 2019, to May 31, 2019) and during the COVID-19 pandemic (from January 1, 2020, to May 31, 2020). The case group consisted of 231 end-of-life inpatients during the pandemic, control group was composed of the pool of inpatients with pre-pandemic and matched with cases by sex and age in a 1:1 ratio. RESULTS: The results showed that the prevalence of respiratory failure symptoms ( = 0.004), residing in long-term care facilities ( = 0.017), palliative care needs assessment scores ( = 0.010), as well as the provision of guidance for nasogastric tube feeding ( = 0.002), steam inhalation ( = 0.003), turning and positioning ( < 0.001), percussion ( < 0.001), passive range of motion ( < 0.001), and blood pressure measurement ( < 0.001). Furthermore, the assessment of the necessity for assistive devices, including hospital beds, also exhibited statistically significant variations ( < 0.001). Further investigation of the factors associated with high palliative care needs and the risk of mortality for both the case and control groups. Risk factors for high palliative care needs encompassed assessments of daily activities of living, the presence of pressure ulcers, and the receipt of guidance for ambulation. Risk factors for mortality encompassed age, a diagnosis of cancer, palliative care needs assessment scores, and the provision of guidance for disease awareness. CONCLUSION: This research highlights the heightened risk of COVID-19 infection among end-of-life inpatients during the COVID-19 pandemic. The findings of this study may advance care planning to alleviate avoidable suffering. To meet the needs of inpatients during pandemic, healthcare professionals should undergo comprehensive palliative care training and receive policy support.
背景：在 COVID-19 大流行之前和期间，台湾对住院患者的姑息治疗预防措施和出院计划服务提供情况并未进行调查。本研究旨在探讨与姑息治疗需求增加和死亡率增加相关的因素。
方法：本研究采用回顾性病例对照研究设计。调查包括大流行前（2019 年 1 月 1 日至 2019 年 5 月 31 日）和 COVID-19 大流行期间（2020 年 1 月 1 日至 2020 年 5 月 31 日）入院的患者。病例组由 231 名大流行期间临终患者组成，对照组由大流行前与病例组按性别和年龄 1:1 匹配的患者组成。
结果：结果表明，呼吸衰竭症状的患病率（=0.004）、居住在长期护理机构（=0.017）、姑息治疗需求评估评分（=0.010）以及鼻胃管喂养指导（=0.002）、蒸汽吸入（=0.003）、翻身和定位（<0.001）、叩击（<0.001）、被动关节活动度（<0.001）和血压测量（<0.001）。此外，对包括病床在内的辅助设备需求的评估也存在统计学显著差异（<0.001）。进一步调查了病例组和对照组高姑息治疗需求和死亡风险的相关因素。高姑息治疗需求的危险因素包括日常生活活动评估、压疮存在和行走指导。死亡的危险因素包括年龄、癌症诊断、姑息治疗需求评估评分以及疾病意识指导。
结论：本研究强调了 COVID-19 大流行期间临终患者感染 COVID-19 的风险增加。本研究的结果可以推进护理计划，减轻可避免的痛苦。为满足大流行期间住院患者的需求，医护人员应接受全面的姑息治疗培训并获得政策支持。
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