Millar D G, Carroll D, Grimshaw J, Watt B
Department of General Practice, University of Aberdeen.
Br J Gen Pract. 1998 Jun;48(431):1299-302.
Ninety per cent of the last year of life of cancer patients is spent at home. Some studies have suggested that care in this setting is often suboptimal. Information on the standard of palliative care delivered at home by general practitioners (GPs) and their teams is limited, and clarification of the problems faced is needed.
To audit the home-based palliative care of patients dying of cancer.
Matched postal questionnaires were sent to the GPs and nurses of 1086 successive patients dying of cancer in whatever setting in the Grampian region of Scotland some six weeks after the death to establish the professionals' perception of symptom control, communication problems, use of services, and information given to patients and relatives.
Response rates were 88.8% for GPs (964 out of 1086) and 87.1% for nurses (325 out of 375 that were passed on to nurses). Two-thirds of patients received palliative care at home. Pain was poorly controlled in 15.7%, and poor control of other symptoms ranged from 13.8% (nausea and vomiting) to 21% (depression and dyspnoea). Communication difficulties were present in 93.7% of cases, although only 5.2% of these were of a major nature. District nurses were involved in 76.7% of cases and Macmillan nurses in 28.0%. Twenty-six per cent of referrals to district nurses were assessed as being late in the course of the illness. Patients were fully informed about the diagnosis in 66.3% of cases and about the prognosis in 55.4%. General practitioners were more likely to report the presence of communication problems between themselves and the patient (when compared with nurses: 43.9% versus 28.0%), more likely to report that patients were 'not at all informed' about self-help groups (57.5% versus 36.3%), and were less likely to report the involvement of occupational therapists (21.8% versus 39.7%).
Levels of reporting of poor symptom control by professionals was much lower than levels reported by relatives in other studies, but there was no difference between the reporting of GPs and nurses. However, a number of areas were identified where care could be enhanced by improved teamwork and further education and training in symptom control, as well as in communication, use of services, and information provision.
癌症患者生命的最后一年中有90%是在家中度过的。一些研究表明，这种情况下的护理往往不尽如人意。关于全科医生（GP）及其团队在家中提供的姑息治疗标准的信息有限，需要明确所面临的问题。
审核死于癌症患者的居家姑息治疗情况。
在苏格兰格兰扁地区，向1086例连续死于癌症的患者（无论其死亡地点）的全科医生和护士在患者死亡约六周后邮寄配对问卷，以了解专业人员对症状控制、沟通问题、服务使用以及向患者和亲属提供信息的看法。
全科医生的回复率为88.8%（1086例中的964例），护士的回复率为87.1%（转交给护士的375例中的325例）。三分之二的患者在家中接受姑息治疗。15.7%的患者疼痛控制不佳，其他症状控制不佳的比例从13.8%（恶心和呕吐）到21%（抑郁和呼吸困难）不等。93.7%的病例存在沟通困难，不过其中只有5.2%属于严重性质。76.7%的病例有地区护士参与，28.0%的病例有麦克米伦护士参与。转介给地区护士的病例中有26%在病程后期才得到评估。66.3%的病例中患者充分了解了诊断情况，55.4%的病例中患者充分了解了预后情况。与护士相比，全科医生更有可能报告自己与患者之间存在沟通问题（43.9%对28.0%），更有可能报告患者“完全不了解”自助组织的情况（5
