Grimm Jana Sophie, Kasdorf Alina, Voltz Raymond, Strupp Julia
Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, 50937 Cologne, Germany.
Center for Health Services Research, Faculty of Medicine and University Hospital, University of Cologne, 50937 Cologne, Germany.
Healthcare (Basel). 2025 Aug 16;13(16):2024. doi: 10.3390/healthcare13162024.
: Early identification of terminally ill patients is crucial for enhancing care, patient and care partner satisfaction, and healthcare staff confidence in discussing disease trajectories. Yet, timely recognition remains challenging. To address this, we developed a minimally invasive intervention (MINI) for general hospital wards. We aimed to evaluate the MINI's feasibility in facilitating an earlier identification of terminally ill patients and improving patient reported outcomes in a hospital setting. : This prospective, two-arm pre-post intervention study at a university hospital evaluated the MINI alongside usual care. Patient-reported outcomes, including quality of life (SF-12), palliative care needs (IPOS), and functional status (ECOG), were collected at baseline and every three months over 12 months. Participants were allocated to a control or intervention group. : Of 188 patients identified using the Surprise Question, 58 completed the baseline assessment. While physical functioning (SF-12 PCS) remained comparable, the intervention group experienced clinically meaningful improvements in mental health (SF-12 MCS) at three months, with positive trends at six months. This group also showed a decline in palliative care needs, reduced emotional symptoms, and improved performance status, evidenced by significant differences in non-parametric analyses. These findings underscore the MINI's potential to significantly improve patient well-being. : This pilot study demonstrated the feasibility of the MINI and suggests it may foster meaningful system-wide change in patient-centred care within acute hospital settings, leading to improved patient outcomes and more confident healthcare staff in identifying terminally ill patients. However, given the small sample size, these findings should be interpreted with caution. Future research with larger cohorts and extended intervention periods is warranted to fully elucidate the MINI's impact and refine strategies for improving care for terminally ill patients.
早期识别晚期患者对于加强护理、提高患者及护理伙伴满意度以及医护人员讨论疾病发展轨迹的信心至关重要。然而，及时识别仍然具有挑战性。为解决这一问题，我们为综合医院病房开发了一种微创干预措施（MINI）。我们旨在评估MINI在促进早期识别晚期患者以及改善医院环境中患者报告结局方面的可行性。
这项在大学医院进行的前瞻性双臂干预前后对照研究，将MINI与常规护理进行了评估。在基线时以及12个月内每三个月收集一次患者报告的结局，包括生活质量（SF - 12）、姑息治疗需求（IPOS）和功能状态（ECOG）。参与者被分配到对照组或干预组。
在使用“意外问题”识别出的188名患者中，58名完成了基线评估。虽然身体功能（SF - 12身体成分总结）保持相当，但干预组在三个月时心理健康（SF - 12心理成分总结）有临床意义的改善，六个月时有积极趋势。该组还显示姑息治疗需求下降、情绪症状减轻以及表现状态改善，非参数分析中的显著差异证明了这一点。这些发现强调了MINI在显著改善患者福祉方面的潜力。
这项试点研究证明了MINI的可行性，并表明它可能在急性医院环境中促进以患者为中心的护理在全系统产生有意义的变化，从而改善患者结局，并使医护人员在识别晚期患者时更有信心。然而，鉴于样本量小，这些发现应谨慎解释。有必要进行更大队列和更长干预期的未来研究，以充分阐明MINI的影响并完善改善晚期患者护理的策略。
