共查询到19条相似文献,搜索用时 125 毫秒
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目的 评估姑息关怀服务对癌症晚期患者生命质量的影响并提出管理建议。方法 采用问卷调查的方式对H医院接受姑息关怀治疗和常规抗癌治疗的248名癌症晚期住院患者的生命质量进行调查。选取中国癌症患者生命质量量表对癌症晚期患者的生命质量进行评估,然后通过统计分析探讨不同治疗方式下患者生命质量的差异。结果 癌症晚期患者生命质量普遍较差(36.38±4.82),其中躯体症状得分最低,依次是精神心理和社会关系。接受姑息关怀后患者生命质量及各指标得分均有显著提高。治疗前生命质量更差、疼痛程度更高的姑息关怀组患者,其治疗后的生命质量评分与常规抗癌组患者相比无显著差异,疼痛程度更是低于常规抗癌组。两组治疗方式下患者生命质量治疗前后的差值对比(6.82±2.71 vs 2.53±2.95),姑息关怀组的改善效果更明显(t=11.908,P<0.05)。结论 姑息关怀治疗相对于常规抗癌治疗,对癌症晚期患者生命质量的改善效果更为显著,应加强对以价值为核心的姑息关怀服务模式的宣传和推广。 相似文献
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赵钰 《中国实用乡村医生杂志》2010,17(9):32-33
晚期肿瘤患者的症状可以用药物解决,但充分而细致的临床护理才是临终关怀的基础,也是减轻患者各种不适和痛苦的重要手段。有效护理有赖于护理人员对患者的了解,建立互相信任、开放、良好的护患关系,是有效护理的根本保证。对于姑息性治疗中的晚期癌症患者,治疗更多地是作为一种支持、安慰、关怀和照顾的手段,减轻其躯体和心理痛苦。基层医院和社区医院应承担主要的临终关怀工作。现结合临床实践,探讨在基层医疗单位中如何建立治疗性护患关系及其在晚期癌症患者姑息治疗中的作用,并报告如下。 相似文献
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目的:评价姑息治疗方法治疗疾病晚期患者的疗效。方法:对所收治的86例患者采用心理治疗、扶正培本治疗、个性化的“三阶梯”止痛治疗。结果:姑息治疗能改善疾病晚期患者的精神状态,使其变得乐观,树立了信心和家属一起积极配合治疗,极大地提高了其终末期的生存质量,减轻和延长了其无症状生存期,同时减轻了家属的经济压力和自行护理的负担,是患者及家属乐于接受和认可的一种治疗方法。结论:姑息治疗对于疾病晚期的患者是有效的,值得医疗机构推广。 相似文献
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手术和放化疗等主张对癌细胞“赶尽杀绝”的根治性治疗手段,对于绝大部分代谢功能降低,脏器功能减退和伴发疾病增多的老年肿瘤患者来说,并不恰当,温和的姑息治疗反而更稳妥。 相似文献
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《中国卫生经济》2016,(5)
目的:对国际发表的临终患者姑息治疗的临床随机对照研究(randomized controlled trail,RCT)的成本-效果评估文献进行系统综述,为我国支付及临床决策提供姑息疗法成本和成本-效果研究依据。方法:纳入2000年至2015年间国际发表的姑息治疗和常规治疗的RCT研究文献,对姑息治疗临床产出、相关成本及成本-效果研究进行汇总。结果:最终有6项RCT研究纳入本次系统综述分析。结果显示与常规治疗相比,在临终阶段实施姑息治疗不仅可以使患者的临床症状控制平稳、生命质量提高、缓解抑郁情绪、照顾满意度提高,而且患者生存期不会缩短,甚至延长。对临床资源使用情况显示,姑息治疗更少采用激进治疗,因此带来医疗费用的大量节省。结论:对临终期患者实施姑息治疗具有非常好的成本-效果优势,我国积极推动姑息治疗将会带来巨大的临床收益,并提高医疗资源的使用效率。 相似文献
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《中国城乡企业卫生》2016,(9)
只有约30%的结直肠癌伴肝转移的患者能够接受同时切除肝脏转移病变的根治性治疗。由于原发肿瘤的病变程度以及患者合并症的存在,姑息性治疗是不可切除患者唯一的选择。在一些病例中姑息性治疗可以局部或是全身控制肿瘤,延长存活时间。由于技术的逐渐进步,新的姑息性治疗方法在临床试验中得到检测并随后进入临床实践。本文就多学科间进行结直肠癌肝转移姑息性治疗的决策制定进行分析和总结。 相似文献
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Substantial shortfalls in the quality of palliative care of the elderly can be attributed to 5 fundamental flaws in the way end-of-life care is currently delivered. First, palliative care is viewed as a terminal event rather than a longitudinal process, resulting in a reactive approach and unnecessary preterminal distress in elderly patients suffering from chronic, slowly progressive illnesses. Second, palliative care is defined in terms of a false dichotomy between symptomatic and disease-focused treatment, which distracts attention from the proper focus of healing illness. Third, the decision about whether the focus of care should be palliative is not negotiated among patients, family members, and providers. Fourth, patient autonomy in making treatment choices is accorded undue prominence relative to more salient patient choices, such as coming to terms with their place in the trajectory of chronic illness. Fifth, palliative care is a parallel system rather than an integrated primary care process. A new theoretical framework--the TLC model--addresses these flaws in the provision of palliative care for elderly persons. In this model, optimal palliative care is envisioned as timely and team oriented, longitudinal, collaborative and comprehensive. The model is informed by the chronic illness care, shared decision making, and comprehensive geriatric assessment research literature, as well as previous palliative care research. Preliminary results of an intervention for elderly assisted living residents based on the TLC model support its promise as a framework for optimizing palliative care of elders. 相似文献
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Poliakov IV Zelenskaia TM Liptuga ME 《Problemy sot?sial?no? gigieny, zdravookhranenii?a i istorii medit?siny / NII sot?sial?no? gigieny, ?konomiki i upravlenii?a zdravookhraneniem im. N.A. Semashko RAMN ; AO "Assot?siat?sii?a 'Medit?sinskai?a literatura'."》2000,(3):30-32
Creation of a system of palliative care in the Russian Federation is a pressing problem of public health, which at present is going through the first stage of development. According to WHO estimations, at least 75% cancer patients need palliative care. The system of medical care to cancer patients functioning in countries with well-developed economy (United Kingdom, USA, Canada, Australia) intends equal distribution of resources between radical treatment and palliative care (including analgesia) and reflects the actual requirements of patients. The scope of care should be extended from symptomatic treatment to comprehensive (medical, psychological, social, and spiritual) care of patients and their families. 相似文献
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Yamagishi A Morita T Miyashita M Akizuki N Kizawa Y Shirahige Y Akiyama M Kei Hirai Kudo T Yamaguchi T Fukushima A Eguchi K 《The American journal of hospice & palliative care》2008,25(5):412-418
Palliative care is an essential part of integrated cancer treatment. To improve palliative care throughout Japan, a nationwide demonstration project, the Outreach Palliative Care Trial of Integrated Regional Model (OPTIM) study, is ongoing. This article reviews the current status and the problems of palliative care in Japan and introduces the OPTIM study. Although the number of palliative care services is increasing, empirical evidence shows the quality of life of cancer patients is still inadequate. The OPTIM study is an intervention trial targeting 4 areas across Japan. Primary end points are quality of care reported by patients as well as the bereaved family, number of patients who received specialized palliative care services, and place of death. The interventions are comprehensively designed to cover all areas identified by the national task force. The OPTIM study will contribute to improve patients' quality of life by proposing a regional palliative care model suitable for Japan. 相似文献
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Although standards for palliative treatment of cancer patients at end of life are available, their use is perceived to vary among institutions depending on the prevailing philosophy of care. In this retrospective study, we reviewed the treatment of dying cancer patients receiving intravenous morphine transferred from a cancer center to a palliative care hospital. We recorded the dose of morphine and the use of other palliative medications, including adjuvant analgesic drugs. Although morphine doses tended to decrease after the transfer, the use of palliative medications was similar in the two institutions. 相似文献
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Zimmerman K Rudolph J Salow M Skarf LM 《The American journal of hospice & palliative care》2011,28(7):501-510
Patients receiving palliative care often possess multiple risk factors and predisposing conditions for delirium. The impact of delirium on patient care in this population may also be far-reaching: affecting not only quality of remaining life but the dying process experienced by patients, caregivers, and the medical team as well. As palliative care focuses on comfort and symptom management, the approach to assessment and subsequent treatment of delirium in palliative care patients may prove difficult for providers to navigate. This article summarizes the multifactorial nature, numerous predisposing medical risk factors, neuropsychiatric adverse effects of palliative medications, pharmacokinetic changes, and challenges complicating delirium assessment and provides a systematic framework for assessment. The benefits, risks, and patient-specific considerations for treatment selection are also discussed. 相似文献
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Stolick M 《The American journal of hospice & palliative care》2002,19(1):29-34
A meaningful death can be fostered for a patient and his or her family with the aid of medical treatment, specifically through the alleviation of the patient's suffering and pain. To recognize the dying process is a part of the art of medicine. Compassionate care for dying patients includes a move from a curative model of care to a palliative model of care in defining the primary goal. Hospice volunteer training and practice is sufficient palliative care training to develop these skills. The time has come for incorporating palliative care into the curriculum of medical school. 相似文献
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Cremer-Schaeffer P Radbruch L 《Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz》2012,55(2):231-237
In Germany, palliative care has developed rapidly since the establishment of the first palliative care unit in 1983. More improvements in patient-centered care are only possible if legal requirements as well as education of physicians, nurses, and other professionals involved in palliative care are adapted to current needs. This paper provides an overview of legal and regulatory requirements including a critical appreciation of their influence on palliative care in Germany. Only recently has medical education in palliative medicine been implemented as an integral part of medical studies at German universities. Starting in 2014, physicians applying for a license to practice medicine will have to provide a certificate of basic training in this field. The challenge in upcoming years will be the establishment and enhancement of comprehensive, standardized, and quality-controlled education at the universities. Only six universities have established chairs for palliative medicine, and it will be essential to not only establish more chairs but also to involve medical students in the development of the education. Only minimal requirements are specified for education of nurses in palliative care in the legislation. However, standardized and quality-controlled advanced training courses are available. This training is frequently requested as a prerequisite for nurses working in palliative care. Only limited education programs exist for other professional groups that are an important part of the palliative care team. In addition to the development of palliative care for inpatients with an increasing number of palliative care units, hospices, and first chairs of palliative medicine, different forms of ambulant palliative care services have been developed. Changes in the legislation have influenced the situation for home care enormously in the last 5?years, also making it more complex. With the Law for the Consolidation of the Competition in Compulsory Health Insurance ("Gesetz zur St?rkung des Wettbewerbs in der gesetzlichen Krankenversicherung"), a legal claim for palliative home care has been implemented in the fifth book of the social law in 2007. The ambitious goal of full coverage with comprehensive palliative home care has still not been achieved in most locations. However, after initial negotiation difficulties between palliative care providers and health insurance funds, an increasing number of contracts have been made. As a consequence-in addition to more than 240 palliative care units in Germany-more than one hundred palliative care teams have begun work in the field of specialized palliative home care. Legal regulations for the supply of opioids and other medications for the treatment of patients at home have been adapted recently, thus, facilitating fast and comprehensive medical treatment in emergency situations. Overall, the legislation has been adapted significantly, hence, contributing to improvements for patients requiring palliative care. It remains to be seen whether additional adjustments are required in the future. 相似文献
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National Ethics Committee Veterans Health Administration 《The American journal of hospice & palliative care》2006,23(6):483-491
Many patients nearing the end of life reach a point at which the goals of care change from an emphasis on prolonging life and optimizing function to maximizing the quality of remaining life, and palliative care becomes a priority. For some patients, however, even high-quality aggressive palliative care fails to provide relief. For patients suffering from severe pain, dyspnea, vomiting, or other symptoms that prove refractory to treatment, there is a consensus that palliative sedation is an appropriate intervention of last resort. In this report, the National Ethics Committee, Veterans Health Administration examines what is meant by palliative sedation, explores ethical concerns about the practice, reviews the emerging professional consensus regarding the use of palliative sedation for managing severe, refractory symptoms at the end of life, and offers specific recommendations for institutional policy. 相似文献
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Chronic obstructive pulmonary disease (COPD) is a major cause of disability, morbidity and mortality in old age. Patients
with advanced stage COPD are most likely to be admitted three to four times per year with acute exacerbations of COPD (AECOPD)
which are costly to manage. The adverse events of AECOPD are associated with poor quality of life, severe physical disability,
loneliness, and depression and anxiety symptoms. Currently there is a lack of palliative care provision for patients with
advanced stage COPD compared with cancer patients despite having poor prognosis, intolerable dyspnoea, lower levels of self
efficacy, greater disability, poor quality of life and higher levels of anxiety and depression. These symptoms affect patients'
quality of life and can be a source of concern for family and carers as most patients are likely to be housebound and may
be in need of continuous support and care. Evidence of palliative care provision for cancer patients indicate that it improves
quality of life and reduces health care costs. The reasons why COPD patients do not receive palliative care are complex. This
partly may relate to prognostic accuracy of patients' survival which poses a challenge for healthcare professionals, including
general practitioners for patients with advanced stage COPD, as they are less likely to engage in end-of-life care planning
in contrast with terminal disease like cancer. Furthermore there is a lack of resources which constraints for the wider availability
of the palliative care programmes in the health care system. Potential barriers may include unwillingness of patients to discuss
advance care planning and end-of-life care with their general practitioners, lack of time, increased workload, and fear of
uncertainty of the information to provide about the prognosis of the disease and also lack of appropriate tools to guide general
practitioners when to refer patients for palliative care. COPD is a chronic incurable disease; those in an advanced stage
of the disease pursuing intensive medical treatment may also benefit from the simultaneous holistic care approach of palliative
care services, medical services and social services to improve quality of end of life care. 相似文献