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利用审核改善三级癌症中心的临终关怀

Using Audit to Improve End-of-Life Care in a Tertiary Cancer Centre.

作者信息

Moloney Conor D, Carroll Hailey K, Cunningham Elaine, Nuzum Daniel, Lyons Mairead, Bambury Richard M, Collins Dearbhaile C, Connolly Roisín M, O'Donovan Paula, Sumugat Renelyn, Iqbal Shahid, Noonan Sinead A, Power Derek G, Lowney Aoife C, O'Reilly Seamus, O'Leary Mary Jane

机构信息

Cork University Hospital, Wilton, T12 DC4A Cork, Ireland.

Marymount University Hospital and Hospice, T12 A710 Cork, Ireland.

出版信息

Curr Oncol. 2025 Jul 30;32(8):430. doi: 10.3390/curroncol32080430.

Abstract

High-quality end-of-life care (EoLC) is a critical yet often underemphasised component of oncology care. Several shortcomings in the delivery of EoLC for oncology patients in our centre during the COVID-19 pandemic were identified in our initial 2021 audit. In 2022, we introduced a care of dying patients proforma, an EoLC quality checklist, targeted education and training for staff, and an expanded end-of-life (EoL) committee. This re-audit aimed to review how these changes impacted on the care received by patients in a tertiary cancer centre. A second retrospective re-audit of patients who died between 11 July 2022 and 30 April 2023 was performed to assess quality of EoLC using the Oxford Quality indicators. A total of 72 deaths occurred over the audit period. Quality of EoLC improved significantly when compared to the initial audit (χ (3, = 138) = 9.75, = 0.021). Exploration of patients' wishes was documented in 48.8% and referral to pastoral care was documented in 68.3%, from 24.2% and 10.6%, respectively. The proportion of patients receiving poor EoLC reduced from 21.2% to 8.3%. Our study demonstrates the benefits of simple interventions, the importance of re-audit, and the role of ongoing interdisciplinary commitment to improving EoLC for our patients.

摘要

高质量的临终关怀(EoLC)是肿瘤护理中一个关键但常被忽视的组成部分。在我们2021年的首次审计中,发现了在新冠疫情期间我们中心为肿瘤患者提供临终关怀时存在的几个不足之处。2022年,我们引入了一份临终患者情况表、一份临终关怀质量检查表、针对工作人员的定向教育和培训,以及一个扩大的临终关怀(EoL)委员会。这次重新审计旨在评估这些变化如何影响一家三级癌症中心患者所接受的护理。对2022年7月11日至2023年4月30日期间死亡的患者进行了第二次回顾性重新审计,以使用牛津质量指标评估临终关怀质量。在审计期间共发生了72例死亡。与首次审计相比,临终关怀质量有了显著改善(χ(3, = 138) = 9.75, = 0.021)。记录了对患者意愿探索的比例从24.2%提高到了48.8%,记录了转介至宗教关怀的比例从10.6%提高到了68.3%。接受低质量临终关怀的患者比例从21.2%降至8.3%。我们的研究证明了简单干预措施的益处、重新审计的重要性,以及持续的跨学科致力于改善我们患者临终关怀的作用。

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