Addington-Hall J, McCarthy M
Department of Epidemiology and Public Health, University College London, UK.
Palliat Med. 1995 Oct;9(4):295-305. doi: 10.1177/026921639500900404.
To describe the quality of care received in the last year of life by people who die from cancer, focusing particularly on symptom control, communication with health professionals, and care in the community.
Interview survey of family members or others who knew about the last year of life of a random sample of people who died in the UK in 1990, based upon methods used in nationally representative surveys by Cartwright in 1969, and Cartwright and Seale in 1987.
Twenty district health authorities from a range of inner city, outer urban and rural settings. Although self-selected, districts were nationally representative in terms of social characteristics and on many indicators of health service provision and usage.
Interviews were obtained for 2074 cancer deaths out of a random sample of 2915, a 71% response rate.
At some stage in the last year of life, 88% were reported to have been in pain, 66% were said to have found it to be 'very distressing', and 61% to have experienced it in their last week. Treatment that only partially controlled the pain, if at all, was said to have been received by 47% of those treated for pain by their GPs and by 35% of hospital patients. Other common symptoms experienced by more than half the sample in their last year were loss of appetite, constipation, dry mouth or thirst, vomiting or nausea, breathlessness, low mood, and sleeplessness. Half of the respondents (51%) were unable to get all the information they wanted about the patient's medical condition when they wanted it. Relatives bore the brunt of caring for 81% of the sample. Of respondents who had helped to care for the deceased, 65% said that their activities had been at least fairly restricted, but 53% had found it rewarding. District nurses had helped 60% of the deceased, 20% had had a home help, and 9% had received 'meals on wheels'. More help with activities of daily living was reported to have been needed by 31%; 24% were reported to have needed more help with domestic chores; 25% were reported to have needed more financial help, and 29% were reported to have needed either more care from district nurses (if had some) or some care (if had none).
There is still some way to go before all dying cancer patients receive high quality care. Education in the principles of palliative care is needed at all levels of the NHS if high standards are to be reached. In addition, adequate resources are required to meet the social and health care needs of cancer patients at home. There is, as yet, no room for complacency about the care of dying cancer patients.
描述死于癌症者在生命最后一年所接受的护理质量，尤其关注症状控制、与医护人员的沟通以及社区护理情况。
对1990年在英国死亡的随机抽样人群中了解其生命最后一年情况的家庭成员或其他人进行访谈调查，采用的方法基于卡特赖特1969年以及卡特赖特和西尔1987年进行的具有全国代表性的调查。
来自一系列内城区、外城区和农村地区的20个地区卫生当局。尽管这些地区是自行选择的，但在社会特征以及许多卫生服务提供和使用指标方面具有全国代表性。
在2915个随机样本中，成功访谈了2074例癌症死亡案例，回复率为71%。
在生命的最后一年的某个阶段，据报告88%的人曾遭受疼痛，66%的人表示疼痛“非常痛苦”，61%的人在生命的最后一周经历过疼痛。全科医生治疗的疼痛患者中有47%、医院患者中有35%表示接受的治疗只是部分控制了疼痛，甚至根本没有控制住。样本中超过半数的人在生命最后一年还经历过的其他常见症状包括食欲不振、便秘、口干或口渴、呕吐或恶心、呼吸急促、情绪低落和失眠。一半的受访者（51%）在需要时无法获取他们想要的关于患者病情的所有信息。81%的样本主要由亲属照顾。在曾帮助照顾逝者的受访者中，65%表示他们的活动至少受到了相当程度的限制，但53%的人觉得这是有意义的。地区护士帮助了60%的逝者，20%的人得到过家政服务帮助，9%的人接受过“送餐上门”服务。据报告，31%的人需要更多日常生活活动方面的帮助；24%的人需要更多家务方面的帮助；25%的人需要更多经济援助，29%的人需要要么得到地区护士更多的护理（如果之前得到过一些护理），要么得到一些护理（如果之前没有得到过护理）。
在所有临终癌症患者都能获得高质量护理之前，仍有很长的路要走。如果要达到高标准，英国国家医疗服务体系的各级人员都需要接受姑息治疗原则的教育。此外，需要足够的资源来满足癌症患者在家中的社会和医疗护理需求。对于临终癌症患者的护理，目前仍不能自满。
