Gonçalves Florbela, Gaudêncio Margarida, Paiva Ivo Cristiano Soares, Rego Francisca, Nunes Rui
Portuguese Institute of Oncology Francisco Gentil Coimbra, 3000-075 Coimbra, Portugal.
Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal.
Healthcare (Basel). 2024 Aug 1;12(15):1529. doi: 10.3390/healthcare12151529.
Palliative care (PC) corresponds to an approach that enhances the quality of life for patients facing life-threatening diseases, such as cancer, as well as for their families. There are various models for providing palliative care. Early referral to PC of patients with advanced cancer has a significant positive impact on their quality of life. However, the criteria for early referral still remain controversial.
To evaluate patients' symptomatic intensity and perception of quality of life on admission to a PC unit and to analyze these two variables according to different models of approach (outpatient and inpatient care).
A cross-sectional, descriptive, and correlational study was conducted with a sample of 60 patients sequentially admitted to a PC unit from palliative outpatient consultations or other inpatient services in a tertiary hospital dedicated to oncology care. The evaluation protocol included a sociodemographic and medical questionnaire, the Edmonton Symptom Assessment Scale (ESAS), and the Palliative Care Outcome Scale (POS) completed by patients within the first 24 h after admission.
The participants were mostly male (61.7%), with a median age of 72 years. The majority of patients ( = 32; 53.3%) were undergoing outpatient treatment, while the remaining individuals ( = 28; 46.7%) were transferred from other hospital services (inpatient care). In the outpatient care group, higher scores for fatigue and dyspnea were observed. Conversely, in the inpatient care group, higher scores were observed for pain, depression, and anxiety. There were significant differences between the two groups regarding the POS dimensions of meaning of life, self-feelings, and lost time. In the inpatient group, there was a longer time between diagnosis and referral to PC; however, it was also in the inpatient group that there was less time between PC referral and first PC evaluation, between PC referral and PC unit admission, and between PC referral and death. There were no significant correlations between referral times and ESAS/POS scores in the inpatient and outpatient groups.
The patients admitted to the Palliative Care Unit presented a high symptom burden and changes in the perception of quality of life. However, there are no statistically significant differences between one model of approach in relation to the other. It was found that poorer symptom control and quality of life were associated with a shorter referral time for PC, because this was only initiated after curative care was suspended, particularly in our institutional context. Early referrals to the PC team are essential not only to relieve symptom-related distress but also to improve treatment outcomes and quality of life for people with cancer.
姑息治疗（PC）是一种提高面临危及生命疾病（如癌症）患者及其家属生活质量的方法。提供姑息治疗有多种模式。晚期癌症患者早期转诊至姑息治疗对其生活质量有显著积极影响。然而，早期转诊的标准仍存在争议。
评估患者入住姑息治疗病房时的症状强度和生活质量感知，并根据不同的治疗模式（门诊和住院治疗）分析这两个变量。
对一家专门从事肿瘤护理的三级医院中，从姑息门诊咨询或其他住院服务依次入住姑息治疗病房的60例患者进行了横断面、描述性和相关性研究。评估方案包括一份社会人口统计学和医学问卷、埃德蒙顿症状评估量表（ESAS）以及患者在入院后24小时内完成的姑息治疗结果量表（POS）。
参与者大多为男性（61.7%），中位年龄为72岁。大多数患者（n = 32；53.3%）接受门诊治疗，其余患者（n = 28；46.7%）从其他医院科室转入（住院治疗）。在门诊治疗组中，疲劳和呼吸困难得分较高。相反，在住院治疗组中，疼痛、抑郁和焦虑得分较高。两组在生活意义、自我感受和失去时间等POS维度上存在显著差异。在住院组中，从诊断到转诊至姑息治疗的时间较长；然而，也是在住院组中，从姑息治疗转诊到首次姑息治疗评估、从姑息治疗转诊到入住姑息治疗病房以及从姑息治疗转诊到死亡之间的时间较短。住院组和门诊组的转诊时间与ESAS/POS得分之间无显著相关性。
入住姑息治疗病房的患者症状负担较重，生活质量感知发生变化。然而，一种治疗模式与另一种治疗模式之间在统计学上无显著差异。研究发现，症状控制较差和生活质量较低与较短的姑息治疗转诊时间相关，因为这仅在暂停根治性治疗后才开始，特别是在我们的机构环境中。早期转诊至姑息治疗团队不仅对于缓解与症状相关的痛苦至关重要，而且对于改善癌症患者的治疗结果和生活质量也至关重要。
