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癌症患者临终前 6 个月的姑息治疗咨询与生命末期质量的关联。

Associations between palliative-care consultations and end-of-life quality in cancer patients' last 6 months.

机构信息

Department of Nursing, National Taiwan University Hospital, Taipei, Taiwain, R.O.C.

Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.

出版信息

Support Care Cancer. 2024 Aug 21;32(9):606. doi: 10.1007/s00520-024-08814-7.

Abstract

PURPOSE

Improving end-of-life (EOL) quality for terminally ill cancer patients is crucial. However, associations between hospice/palliative care and EOL quality, as perceived by patients, are underreported. We aimed to examine the impact of palliative care consultative services on the EOL quality during cancer patients' last six months.

METHODS

In this prospective, longitudinal study, 174 cancer patients were divided into a palliative care consultative services group (n = 65) or a non palliative care consultative services group (n = 109). The impact of palliative care consultative services on EOL quality, assessed using the Quality of Dying and Death (QODD) scale at the first and last assessments within the patients' last six months, was analyzed by linear regression with generalized estimating equations, adjusting for covariates.

RESULTS

Cancer patients received palliative care consultative services a median of 34.0 days before death. There were significant main effects of groups, indicating that patients receiving palliative care consultative services had better QODD total scores (β [95% confidence interval] = 2.12 [0.32,3.93], p = .021), death preparation (3.80 [1.71,5.89], p < .001), and treatment preferences than the reference group (3.27 [0.90,5.64], p = .007). No group differences were found in other dimensions, including symptom and personal care, whole person concern, and time with family.

CONCLUSION

Palliative care consultative services significantly improved cancer patients' perceptions of death preparation, treatment preferences, and the QODD total score. Therefore, healthcare professionals should offer palliative care consultative services to cancer patients, initiate early referrals for such care, and implement effective and individualized interventions to enhance EOL quality.

摘要

目的

提高终末期癌症患者的临终质量至关重要。然而,患者对临终关怀/姑息治疗与临终质量之间关系的感知报告较少。我们旨在研究姑息治疗咨询服务对癌症患者生命最后六个月期间临终质量的影响。

方法

在这项前瞻性、纵向研究中,将 174 名癌症患者分为姑息治疗咨询服务组(n=65)和非姑息治疗咨询服务组(n=109)。使用临终质量和死亡评估量表(QODD),在患者生命最后六个月内的首次和末次评估中,分析姑息治疗咨询服务对临终质量的影响。采用广义估计方程的线性回归分析,调整了协变量。

结果

癌症患者在死亡前中位数 34.0 天接受姑息治疗咨询服务。两组间存在显著的主效应,表明接受姑息治疗咨询服务的患者 QODD 总分(β[95%置信区间]:2.12[0.32,3.93],p=0.021)、死亡准备(3.80[1.71,5.89],p<0.001)和治疗偏好优于参照组(3.27[0.90,5.64],p=0.007)。其他维度,包括症状和个人护理、整体关怀和与家人相处时间,两组间无差异。

结论

姑息治疗咨询服务显著改善了癌症患者对死亡准备、治疗偏好和 QODD 总分的认知。因此,医疗保健专业人员应向癌症患者提供姑息治疗咨询服务,尽早转介此类服务,并实施有效和个性化的干预措施,以提高临终质量。

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