临终患者接受专门的姑息家庭护理后转入住院治疗 - 一项注册研究。

Patients near death receiving specialized palliative home care being transferred to inpatient care - a registry study.

机构信息

Department of Oncology, Faculty of Medicine & Health, Örebro University, SE 70182, Örebro, Sweden.

School of Health Sciences, Faculty of Medicine & Health, Örebro University, SE 70182, Örebro, Sweden.

出版信息

BMC Palliat Care. 2024 Aug 24;23(1):215. doi: 10.1186/s12904-024-01549-6.

DOI:10.1186/s12904-024-01549-6

PMID:39182053

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11344375/

Abstract

BACKGROUND

The majority of palliative care patients express a preference for remaining at home for as long as possible. Despite progression of disease there is a strong desire to die at home. Nonetheless, there are transfers between care settings, demonstrating a discrepancy between desired and actual place of death.

AIM

To map the prevalence of patients near death undergoing specialized palliative home care and being transferred to inpatient care in Sweden.

METHODS

A national retrospective cross-sectional study based on data from the Swedish Register of Palliative Care. Patients ≥ 18 years of age enrolled in specialized palliative home care with dates of death between 1 November 2015 and 31 October 2022 were included (n = 39,698). Descriptive statistics were used.

RESULTS

Seven thousand three hundred eighty-three patients (18.6%), approximately 1,000 per year, were transferred to inpatient care and died within seven days of arrival. A considerable proportion of these patients died within two days after admission. The majority (73.6%) were admitted to specialized palliative inpatient care units, 22.9% to non-specialized palliative inpatient care units and 3.5% to additional care units. Transferred patients had more frequent dyspnoea (30.9% vs. 23.2%, p < 0.001), anxiety (60.2% vs. 56.5%, p < 0.001) and presence of several simultaneous symptoms was significantly more common (27.0% vs. 24.8%, p 0.001).

CONCLUSION

The results show that patients admitted to specialized palliative home care in Sweden are being transferred to inpatient care near death. A notable proportion of these patients dies within two days of admission. Common features, such as symptoms and symptom burden, can be observed in the patients transferred. The study highlights a phenomenon that may be experienced by patients, relatives and healthcare personnel as a significant event in a vulnerable situation. A deeper understanding of the underlying causes of these transfers is required to ascertain whether they are compatible with good palliative care and a dignified death.

摘要

背景

大多数姑息治疗患者表示希望尽可能长时间地留在家里。尽管疾病在进展，但他们强烈希望在家里去世。尽管如此，仍有患者在不同的护理环境之间转移，这表明他们期望的和实际的死亡地点之间存在差异。

目的

描述在瑞典，临近死亡的接受专门的姑息治疗家庭护理的患者数量，并探讨他们转移至住院治疗的情况。

方法

这是一项基于瑞典姑息治疗登记处数据的全国性回顾性横断面研究。纳入年龄≥18 岁、于 2015 年 11 月 1 日至 2022 年 10 月 31 日期间接受专门的姑息治疗家庭护理且死亡日期在该时间段内的患者（n=39698）。采用描述性统计方法。

结果

有 7383 名（18.6%）患者被转移至住院治疗，并在到达后 7 天内死亡，每年约有 1000 名患者。这些患者中有相当一部分在入院后两天内死亡。大多数（73.6%）患者被收入专门的姑息治疗住院病房，22.9%被收入非专门的姑息治疗住院病房，3.5%被收入其他病房。转移患者更频繁出现呼吸困难（30.9%比 23.2%，p<0.001）、焦虑（60.2%比 56.5%，p<0.001），同时存在多种症状的情况更为常见（27.0%比 24.8%，p<0.001）。

结论

研究结果表明，在瑞典接受专门的姑息治疗家庭护理的患者被转移至临终住院治疗。这些患者中有相当一部分在入院后两天内死亡。转移患者存在常见特征，如症状和症状负担。这种现象可能会给患者、家属和医护人员带来冲击，使其处于脆弱的状态。为了确定这些转移是否符合姑息治疗的良好实践和有尊严的死亡，需要深入了解这些转移的根本原因。