Hinton J
St Christopher's Hospice, London, UK.
Palliat Med. 1994;8(3):183-96. doi: 10.1177/026921639400800302.
This prospective study was designed to assess whether patients with terminal cancer, and their relatives, find that competent home care sufficiently maintains comfort and helps adjustment. A random sample from a home care service with readily available beds comprised 77 adults and their relatives who were able and willing to be interviewed separately each week. They were asked the nature and degree of current problems and regular assessments were made of some qualities of life including mood, attitude to the condition, perceived help and preferred place of care. These patients had 90% of their care at home; 29% died at home but 30% were finally admitted for one to three days and 41% for longer. In the final eight weeks, tolerable physical symptoms were volunteered by a mean of 63% each week and psychological symptoms by 17%. Some distress was felt by 11% of patients; this was usually from pain, depression, dyspnoea, anxiety or weakness, and generally did not persist. Relatives suffered grief, strain or their own ill health. Patients' and relatives' reports generally matched except for the strain on carers. Regular assessments found that 64% of patients thought death certain or probable, and 27% thought it possible. Various proportions coped by optimism, fighting their disease, partial suppression or denial, but 50% reached positive acceptance. Relatives were more aware and accepting. About three-quarters of patients and half the relatives were composed, often enjoying life. Serious depression affected 5% of patients and anxiety 4%, but relatives' manifest depression in the later stages increased to 17% and anxiety to 14%. Many consciously disguised their feelings. Treatment was usually praised but realistic preference for home care fell steadily from 100% to 54% of patients and 45% of relatives. At follow-up most relatives approved of where patients had received care and died.
这项前瞻性研究旨在评估晚期癌症患者及其亲属是否认为专业的居家护理足以维持舒适感并有助于适应病情。从一家有现成床位的居家护理服务机构中随机抽取了77名成年人及其亲属，他们能够且愿意每周分别接受访谈。研究人员询问了他们当前问题的性质和程度，并定期对一些生活质量指标进行评估，包括情绪、对病情的态度、感受到的帮助以及首选的护理场所。这些患者90%的护理是在家中进行的；29%在家中去世，但30%最终住院一至三天，41%住院时间更长。在最后八周，平均每周有63%的患者主动报告可耐受的身体症状，17%报告心理症状。11%的患者感到有些痛苦；这种痛苦通常来自疼痛、抑郁、呼吸困难、焦虑或虚弱，且一般不会持续。亲属们遭受着悲伤、压力或自身健康问题。患者和亲属的报告总体相符，但护理人员承受的压力情况除外。定期评估发现，64%的患者认为死亡确定或很有可能，27%认为有可能。不同比例的患者通过乐观、与疾病抗争、部分压抑或否认等方式应对，但50%达到了积极接受的状态。亲属们更有认知且更能接受。约四分之三的患者和一半的亲属心态平和，常常享受生活。严重抑郁影响了5%的患者，焦虑影响了4%，但亲属在后期明显的抑郁发生率增至17%，焦虑发生率增至14%。许多人有意识地掩饰自己的情绪。治疗通常受到赞扬，但对居家护理的实际偏好从100%的患者和45%的亲属稳步下降。随访时，大多数亲属对患者接受护理和去世的场所表示认可。
