Tierney R M, Horton S M, Hannan T J, Tierney W M
Indiana University, USA.
Palliat Med. 1998 Sep;12(5):333-44. doi: 10.1191/026921698670933919.
Hospices were founded to alleviate suffering at the end of life. Quality improvement in hospices should, therefore, target patients' subjective assessments of their care and its outcomes. However, little is known about the relationships among subjective measures of care among hospice patients. The aim was to assess the relationships between hospice patients' physical and psychological symptoms, quality of life, and satisfaction with inpatient care. This was achieved with a prospective cohort study of 42 patients admitted to an Australian hospice's inpatient service during a two-month study period. The Edmonton symptom assessment system, McGill quality of life questionnaire, and a new measure of patients satisfaction with hospice inpatient care were used. It was shown that while there were marked variations in symptoms and quality of life scores, most patients were satisfied with their care. Satisfaction on the day after admission was lower among patients with worse quality of life scores (r = -0.40, P = 0.008), but there was no correlation with symptoms (r = -0.12, P = 0.43). Among the 26 patients (62%) with at least one subsequent inpatient interview, satisfaction was correlated with both worse quality of life (r = -0.51, P = 0.01) and symptoms (r = -0.41, P = 0.05). The symptom, quality of life, and satisfaction scales all had sufficient precision to identify patients with significant changes between the two interviews. It can be concluded that satisfaction with hospice care was associated with quality of life more than symptoms, although symptoms became important later during inpatient stays. Patients can assess their care and can provide valuable information for improving palliative care.
临终关怀机构的设立旨在减轻患者生命末期的痛苦。因此，临终关怀机构的质量改进应以患者对其护理及其结果的主观评估为目标。然而，对于临终关怀患者护理主观指标之间的关系，我们知之甚少。本研究旨在评估临终关怀患者的身体和心理症状、生活质量以及对住院护理的满意度之间的关系。这是通过对42名在为期两个月的研究期间入住澳大利亚一家临终关怀机构住院部的患者进行前瞻性队列研究实现的。研究使用了埃德蒙顿症状评估系统、麦吉尔生活质量问卷以及一项关于患者对临终关怀住院护理满意度的新指标。结果显示，虽然症状和生活质量评分存在显著差异，但大多数患者对其护理感到满意。生活质量评分较差的患者入院后第二天的满意度较低（r = -0.40，P = 0.008），但与症状无关（r = -0.12，P = 0.43）。在26名（62%）至少接受过一次后续住院访谈的患者中，满意度与较差的生活质量（r = -0.51，P = 0.01）和症状（r = -0.41，P = 0.05）均相关。症状、生活质量和满意度量表都具有足够的精度来识别两次访谈之间有显著变化的患者。可以得出结论，对临终关怀护理的满意度与生活质量的关联大于与症状的关联，尽管症状在住院后期变得重要。患者能够评估他们接受的护理，并可为改善姑息治疗提供有价值的信息。
