晚期癌症患者居家姑息照护适宜条件的研究

运用Delphi法,经过3轮专家咨询(15名专家),对在前期研究基础上初拟的晚期癌症患者居家姑息照护适宜条件进行修订.①专家权威系数Ca=0.805;②3轮专家咨询的应答率RR均为100%;③形成了晚期癌症患者居家姑息照护的适宜条件,包括3大内涵和14个子条件:支撑居家姑息照护服务发展的医疗卫生政策(4个子条件)、能够提供居家姑息照护的社区卫生服务(8个子条件)、适宜接受居家姑息照护的服务对象(2个子条件).提出"适宜条件"对居家姑息照护服务的长远发展起到了规范和推动作用;本研究具有一定的创新性,但还需在未来的实践和研究中进一步深化和完善.     

上海市晚期癌症患者姑息照护质量及其影响因素的分析

目的 调查上海市晚期癌症患者的姑息照护质量及其影响因素.方法 采用一般资料调查表和姑息照护结局量表对300例晚期癌症患者进行调查.结果 晚期癌症患者姑息照护质量得分为（16.55±6.47）分;家庭人均月收入、经济压力、遵守医嘱程度、病程、患者是否知晓病情、心理护理、被照护医院等级是影响晚期癌症患者姑息照护质量的主要因素.结论 鉴别晚期癌症患者姑息照护质量的主要影响因素可帮助临床医护人员及相关政策部门制订针对性强的于预对策,以提高晚期癌症患者的照护质量水平,进而提升其生存质量.     

上海市晚期癌症患者居家姑息照护服务内容研究

目的 确定上海市晚期癌症患者居家姑息照护服务的内容及项目.方法 采用Delphi法对15名专家进行2轮咨询.结果 2轮专家咨询的应答率均为100%,专家的权威程度0.864,变异系数<50%的指标占84%,肯德尔和谐系数统计协调性在必要性、技术可行性、人力可行性及风险性方面具有统计学意义(P<0.000).形成了由4项一级指标、26项二级指标、21项三级指标组成的晚期癌症患者居家姑息照护服务内容.结论 专家合作程度及权威程度高,专家意见协调性较好,所形成的服务内容有一定的预测意义和可操作性,但要纳入社区卫生政策,该服务内容仍需在社区进一步验证和完善.     

晚期癌症病人居家姑息照护现状及展望

对晚期癌症病人居家姑息照护的现状、居家姑息照护测量工具、开展居家姑息照护的必要性以及我国居家姑息照护中存在的问题进行综述,以期为我国开展居家姑息照护提供借鉴意见,推动我国居家姑息照护的发展,提高晚期癌症病人居家姑息照护质量。     

晚期癌症患者居家姑息照护服务现状调查及影响因素分析

近年来,癌症已成为我国城乡居民死亡的首要原因,随着老龄化社会的到来,癌症的发病率也呈逐年上升趋势。癌症患者常伴有癌痛、呼吸困难等症状的折磨,导致晚期癌症患者生活质量差,且治疗费用高,很多家庭因病致贫。被诊断为晚期或无法治愈的患者生存的可能性很小,多数癌症患者在生命晚期会选择居家治疗,目前,国外已针对晚期癌症患者广泛开展了居家姑息照护（palliativehomecare）,居家姑息照护不仅可以最大限度地缓解癌症患者疼痛、提高其生存质量,     

专业人员对开展居家姑息照护服务内容必要性的认知调查

目的 针对晚期癌症患者家庭,探讨开展居家姑息照护服务具体内容的必要性。方法 采用自制问卷调查法,对64名社区专业人员和57名三级医院肿瘤科专业人员就开展居家姑息照护服务具体内容必要性进行了调查。两组研究对象平均年龄分别（39．02±10．66）岁、（29．82±5．36）岁;两组在年龄、工作时间、受教育水平均存在差异（P〈0．01）。结果 社区及医院医护人员均以女性为主;两组均积极支持社区开展姑息照护;在对姑息照护熟悉度方面,医院组以熟悉为主,社区组则以了解为主（χ^2=54．55,P〈0．01）;在对社区卫生熟悉度上,社区组以熟悉为主,医院组以了解为主（χ^2=21．31,P〈0．01）。两组在除气管切开护理、胸腹腔抽吸积液、协助处理善后事宜外的28项服务内容认为有必要开展的专业人员所占比例都在79％以上,两者在7项项目上差异有统计学意义（P〈0．05）。结论 社区组与医院组整体上认为有必要开展31项服务内容,但在部分具体内容上意见相左。提示在制定居家姑息照护服务内容相关政策和将其付诸实践时,要综合社区与医院肿瘤专业人员两者的意见。     

对晚期癌症患者实施社区-家庭一体化居家姑息照护的健康教育效果

探讨对晚期癌症患者实施社区-家庭一体化居家姑息照护对其开展健康教育的效果。方法选取本院2015年10月~2016年10月收治的晚期癌症患者72例,随机分成2组,对照组(n=36)采用常规健康教育,观察组(n=36)实施社区-家庭一体化居家姑息照护的健康教育,比较2组临床效果。结果干预前2组QOL评分比较差异无统计学意义(P0.05),干预后观察组评分明显高于对照组,差异有统计学意义(P0.05)。结论对晚期癌症患者实施社区-家庭一体化居家姑息照护,可明显提升其生存质量,值得推广。     

社区卫生服务中心46例终末期癌症患者开展舒缓照护的护理效果评价

摘要：目的 回顾性分析和评价社区卫生服务中心的46例住院终末期癌症患者进行舒缓照护的护理工作。方法 选择四平社区卫生服务中心舒缓照护病区自2012年10月~2013年10月期间病区收住的46例癌症晚期疼痛患者,观察舒缓照护护理前后的患者生活质量各项指标的改变。结果 病区舒缓照护可以明显改善终末期癌症患者的生存质量,并且能舒缓患者家属的不良情绪。结论：社区卫生服务中心舒缓照护护理模式对舒缓终末期癌症患者及家属有着重要意义。     

我国居家姑息照护现状与未来发展构想

随着老龄化人口的增多、不良生活方式和环境污染的影响,疾病死亡谱发生了明显变化.目前,恶性肿瘤已成为我国城乡居民的首位死因.对于晚期恶性肿瘤患者来说,姑息照护是维持生命质量的有效手段.作为姑息照护重要提供方式之一的居家姑息照护,不仅有助于缓解患者痛苦的躯体症状和保持患者良好的心理状态,而且可以减轻家庭经济负担.维持晚期恶性肿瘤患者终末期生命质量.近年来,我国开展了一些形式的居家姑息照护服务,但仍处于初步发展阶段,业内人士对其内涵和发展路仍未达成统一认识.     

上海市社区缺血性脑卒中患者二级预防影响因素的质性研究

目的深入了解社区脑卒中患者二级预防的现状及影响因素,为今后社区更加有效地发展脑卒中二级预防提供参考。方法采用现象学研究方法,对11名社区缺血性脑卒中患者进行半结构式访谈,用现象学分析法进行资料分析。结果社区缺血性脑卒中患者接受脑卒中二级预防主要形式为随访及健康教育;归纳影响社区缺血性脑卒中患者二级预防现状的4个主题为：患者自身因素,政策环境因素,社区卫生服务中心人员因素,照顾者方面因素。结论社区需要不断提高患者对缺血性脑卒中二级预防的认识,加强对缺血性脑卒中二级预防的重视,重视对照护者的支持,完善社区卫生服务中心的相关服务,提高公众的信任和理解。     

晚期肿瘤患者社区卫生服务需求的调查与分析

目的了解晚期肿瘤患者的社区卫生服务需求状况，为更好地开展社区姑息护理提供参考依据。方法采用问卷调查法，对上海市6个社区中的113名晚期肿瘤患者进行调查。结果晚期肿瘤患者对社区姑息护理需求量增加，社区成为肿瘤照护的重要场所。患者在社区中需求的涵盖面较广，且在不同情境下的主要需求有所不同，生理、心理、精神、社会、文化等方面均有所体现。结论应力求构建合理的由多学科专业人员所组成的姑息护理团队作为社区肿瘤照护的基本服务单元。     

Sleep disturbance in family caregivers of patients with advanced cancer

Sleep is a complex process known to be essential for health, well-being, and optimal physical and psychological functioning. Therefore, sleep disturbance may lead to serious consequences. Advanced cancer patients are known to experience a complex constellation of symptoms requiring round-the-clock care. This reality, coupled with the current demographic, social, economic and health policy trends which are shifting palliative care from the hospital to the community setting, will see family members increasingly assuming responsibility for the provision of this care at home. Despite the positive aspects of caregiving, studies report that families experience stress and exhaustion. Given that patient and family constitute the unit of care in palliative care, this area warrants our attention. This article reviews the literature related to family caregivers' disturbed sleep while caring for someone with advanced cancer. What is known and directions for future research will be addressed.     

Palliative care in a Mediterranean culture: a review of services in the Republic of Cyprus

This article reviews the provision of palliative care services in the Republic of Cyprus, highlighting healthcare resources in general and palliative care in particular. An interesting feature of palliative care in Cyprus is the extent to which community palliative care provision appears to be expanding and developing, with hospice care supplementing the work of home care nurses. The role of the home care nurse is discussed and the key role played in patient and family education highlighted. The article raises some interesting features of the relationship between bereavement and culture highlighting the influence that medicalization of health has on traditional ways of caring for patients with cancer and non-cancer conditions.     

The role of palliative care in the home in medical education: report from a national consensus Conference

A working group on teaching palliative care in the home was convened at The National Consensus Conference on Medical Education for Care Near the End of Life. Our consensus statement includes: (1) a justification for education in the home; (2) general guidelines about teaching palliative care at this site; (3) identification of major barriers to training in the home, and some suggestions for overcoming these barriers; and (4) specific suggestions about how and what to teach. We find that the home is an excellent site for training in comprehensive palliative medicine. Housecalls afford an unusually rich and compelling opportunity to learn about the patient's and family's experience of severe illness and the impact of culture and environment on health care, and can have a broad humanizing effect on trainees. We propose that all medical students be familiar with this form of care. Trainees should learn the potential benefits and difficulties of managing terminal illness in the community, appreciate the role of health care teams in assuring safe, secure, high-quality care, and acquire the special knowledge, skills, and attitudes required for providing state-of-the-art palliative care for patients and families facing a terminal illness in the home, including for those dying at home. Instituting education in the home setting will require faculty development, support for more home visiting by physicians, and supervision of trainees in the home by other members of the health care team. Academic medical centers and hospice/home health agencies should collaborate to develop effective training programs.     

Factors predicting home death for terminally ill cancer patients receiving hospital-based home care: the Lyon comprehensive cancer center experience

This study aimed to determine factors favoring home death for cancer patients in a context of coordinated home care. A retrospective study was conducted among patients followed up by the home care coordinating unit of the cancer center of Lyon. The main endpoint was place of death. Univariate analysis included general characteristics (age, gender, rural or urban residence, disease), Karnofsky Index (KI), type of care at referral (chemotherapy, palliative care, or other supportive care), and coordinating medical oncologist (MCO) home visits. Significant factors were used in a logistic regression analysis. Of 250 patients, 90 (36%) had home death. Low KI and MCO home visit were correlated with home death (odds ratio, respectively, 2.1 and 3.1). These results indicate that health care support favors home death. A hospital-based home care unit is effective for bridging the gap between community and hospital. MCO home visits offer concrete support to health care professionals, patients, and relatives.     

Home care of the patient with advanced lung cancer

Improvements in early detection and treatment of lung cancer, as well as health care cost containment, have combined to make home care of the patient with advanced disease common today. Treatments once performed only in medical centers are now routine parts of home care. Families are providing sophisticated bedside care under the guidance of the home care clinician. This article has highlighted home management for the respiratory-related problems of patients with advanced bronchogenic cancer: dyspnea, cough, and hemoptysis. Such patients experience many difficult physical and emotional problems. The home care nurse, as teacher and coordinator, assists the patient and family to live each day to the fullest.     

Home caregivers of the person with advanced cancer: an Australian perspective

Australian palliative care services are predominantly community based, with an emphasis on enabling the person to live at home for as long as possible. Home care of the person with advanced cancer receiving palliative care in the community depends largely on the availability of a family caregiver. Family caregivers are required to assess, monitor, and deliver complex therapeutic interventions such as pain and symptom control, including the administration and adjustment of complex medication regimens. This article reports a study of 42 family caregivers providing home care to persons with advanced cancer. This study sought to describe a number of caregiver variables that may influence reactions to caring roles and caregiver well-being. The study found that family caregivers are significantly involved in symptom management, and that they take on almost total responsibility for routine household tasks. In addition, the caregiver role has a negative impact on caregiver health, schedule, anxiety, and energy. However, caregivers find significant meaning in their role and feel relatively well prepared for caregiving. The results of this study support the applicability of the vast international literature on caregiver issues for the Australian setting and suggest the need to move toward development of caregiver-focused nursing interventions.     

Vietnam: integrating palliative care into HIV/AIDS and cancer care

Vietnam is struggling to meet the growing need for both disease-modifying and palliative care for people with life-threatening chronic diseases such as HIV/AIDS and cancer. Recently, Vietnam initiated rapid development of a national palliative care program for HIV/AIDS and cancer patients that builds on existing palliative care programs and experience and integrates palliative care into standard HIV/AIDS and cancer care. National palliative care guidelines have been issued by the Ministry of Health based on a rapid situation analysis. Plans now call for review and revision of opioid laws and regulations to increase availability of opioids for medical use, training in palliative care for clinicians throughout the country, and development of palliative care programs both in the community and in inpatient referral centers.     

Interval between palliative care referral and death among patients treated at a comprehensive cancer center

In recent years, patients with advanced cancer are referred more frequently to palliative care programs. However, the referrals usually occur relatively late for the management of severe physical and psychological distress. The purpose of this retrospective study was to investigate the interval between palliative care referral and death in patients with advanced cancer. We reviewed charts of 240 consecutive patients with advanced cancer referred to the palliative care program at M.D. Anderson Cancer Center between September and December 2003. Demographics, as well as dates of cancer diagnosis, advanced disease diagnosis, palliative care referral, and death were determined. The median age was 61 years old, 173 were male, 304 patients had solid tumors, and 26 had hematologic malignancies. The median time intervals between the diagnosis of the primary cancer and death, diagnosis of advanced disease and death, advanced disease and palliative care referral, and palliative care referral and death were 33.0 months (95% confidence interval [CI]: 25.8-41.9), 9.4 months (95% CI: 7.9-11.1), 5.6 months (95% CI: 4.3-7.7), and 1.9 months (95% CI: 1.6-2.2), respectively. The patients' median time interval from advanced cancer diagnosis to death and from palliative care referral to death was shorter in patients with hematologic malignancies than in those with sold tumors (p = 0.018 and p < 0.001, respectively). Median time interval between palliative care referral and death was longer for patients less than 65 year old than those 65 years old or more (p = 0.03). Our results should help palliative care and oncology programs at comprehensive cancer centers plan how to develop joint programs for patient care.