安宁疗护对晚期肺癌患者的影响

目的：探讨安宁疗护对晚期肺癌患者的影响。方法：选取2018年1月1日～12月31日60例晚期肺癌患者为对照组,采用常规护理。选取2019年1月1日～12月31日62例晚期肺癌患者为观察组,在常规护理基础上采用安宁疗护,比较两组护理效果。结果：观察组干预后正性心境评分高于对照组(P<0.01),负性心境评分及总分低于对照组(P<0.01);观察组干预后自我感受负担量表(SBP)评分低于对照组(P<0.01);观察组干预后疼痛程度、疼痛对生活的影响、疼痛信念评分低于对照组(P<0.01),疼痛控制满意度评分高于对照组(P<0.01)。结论：安宁疗护可降低晚期肺癌患者的心理痛苦水平和自我感受负担,减轻患者的疼痛程度。     

需求导向型信息支持联合居家舒缓疗护对肺癌晚期患者癌因性疲乏及生活质量的影响

目的探讨需求导向型信息支持联合居家舒缓疗护对肺癌晚期患者癌因性疲乏及生活质量的影响。方法选取2019年1月1日至2021年4月30日靖江市人民医院47例晚期肺癌患者, 采用随机分组法, 将通过筛选并同意参加实验的患者进行编号, 并且以交替的方式分配到观察组和对照组, 观察组25例, 对照组22例。对照组居家接受常规医院舒缓疗护团队护理。观察组实施需求导向型信息支持联合居家舒缓疗护, 采用简易疲乏量表(BFI)、生活质量评分量表(QLQ-C30)比较两组患者癌性疲乏及生活质量。结果观察组肺癌晚期患者综合疲劳程度评分、综合疲劳影响评分明显低于对照组, 差异有统计学意义(P<0.05);观察组患者干预后躯体功能、角色功能、社会功能、情绪功能及认知功能、各项生活质量评分均明显高于对照组, 差异有统计学意义(均P<0.05)。结论需求导向型信息支持联合居家舒缓疗护应用于肺癌晚期患者, 可有效改善患者癌性疲乏, 提升生活质量, 值得临床借鉴。     

心理辅导联合安宁疗护对晚期肿瘤病人应对方式及生活质量的影响

目的:探讨心理辅导联合安宁疗护在晚期肿瘤病人中的应用效果.方法:选取2019年1月—2019年12月医院收治的74例肿瘤晚期病人为研究对象,按随机数字表法分为对照组和观察组各37例.对照组采取常规护理,观察组在常规护理基础上实施心理辅导联合安宁疗护.比较两组病人干预前及干预30 d后应对方式[应对方式问卷(MCMQ)]评分、生活质量[癌症病人生命质量测定量表(EORTCQLQ-C30)]评分、疼痛[疼痛数字评价量表(NRS)]评分.结果:观察组干预30 d后MCMQ中面对维度评分和EORTC QLQ-C30评分明显高于对照组(P<0.05),回避、屈服维度评分和NRS评分明显低于对照组(P<0.05).结论:晚期肿瘤病人实施心理辅导联合安宁疗护能够促进病人养成积极的应对方式,提高其生活质量,利于缓解病人生理疼痛和心理压力.     

安宁疗护对结肠癌根治术后患者认知功能、情绪障碍及自我效能的影响

目的：分析安宁疗护对结肠癌根治术后患者认知功能、情绪障碍及自我效能的影响。方法：回顾性分析2020年1月~2021年3月收治的86例结肠癌根治术后患者临床资料，根据护理方法不同分为对照组和研究组，各43例。对照组实施常规护理，研究组在此基础上实施安宁疗护，连续干预3个月。比较两组癌症治疗功能评估-认知功能量表（FACT-Cog）、心境状态量表（POMS）与中文版癌症自我管理效能感量表（SUPPH）评分。结果：干预后，研究组FACT-Cog量表认知功能、纠正认知障碍及生命质量评分均高于对照组（P＜0.05），两组他人评价评分比较，差异无统计学意义（P＞0.05）；研究组POMS量表各维度评分均低于对照组（P＜0.05），SUPPH量表各维度评分均高于对照组（P＜0.05）。结论：安宁疗护能够提高结肠癌根治术后患者认知功能与自我效能，减轻患者情绪障碍。     

疼痛护理结合临终关怀护理在晚期肝癌患者中的应用效果及对SDS、SAS评分的影响

目的 探讨疼痛护理结合临终关怀护理在晚期肝癌患者中的应用效果及对抑郁自评量表（SDS）、焦虑自评量表（SAS）评分的影响。方法 选取2021年1月至6月本院收治的96例晚期肝癌患者,依据电脑数字表法将其分为对照组和观察组,每组48例。对照组行常规护理,观察组在对照组基础上给予疼痛护理结合临终关怀护理。比较两组的护理效果。结果 护理后,观察组的疼痛数字评分法（NRS）评分低于对照组,汉化版慢性疼痛自我效能感量表（CPSS）评分高于对照组（P<0.05）。护理后,观察组的SDS、SAS评分低于对照组（P<0.05）。观察组的临床干预总依从率高于对照组（P<0.05）。护理后,观察组的心理与生活质量、照护质量评分低于对照组（P<0.05）。结论 疼痛护理结合临终关怀护理可有效改善晚期肝癌患者的疼痛状况、负性情绪,提升临床干预依从性及安宁疗护质量。     

基于奥瑞姆理论的分级照护方案在安宁疗护病房中的实施效果评价

目的探讨基于奥瑞姆理论的分级照护方案在安宁疗护病房中的实施效果。方法选取某社区卫生服务中心安宁病房2020年12月—2022年9月住院的150例晚期癌症患者为研究对象,按照组间基本特征具有可比性的原则分为对照组72例和观察组78例。对照组采用常规护理,观察组根据奥瑞姆理论为指导,拟定安宁疗护分级照护方案,比较两组患者干预前后疼痛评估量表(BPI)、McGill生活质量量表(MQOL)、中文版死亡焦虑量表(T-DAS)评分。结果干预前,两组患者BPI、MQOL、T-DAS评分的比较,差异无统计学意义(P>0.05);干预后,观察组患者BPI评分、T-DAS评分低于对照组,MQOL评分高于对照组,差异均有统计学意义(P<0.05)。结论基于奥瑞姆理论的分级照护方案在安宁疗护病房中的应用,能减轻晚期癌症患者的疼痛程度,改善其死亡焦虑,提高其生存质量。     

安宁疗护在恶性肿瘤晚期患者临终期中的应用

目的观察分析安宁疗护在恶性肿瘤晚期患者中的应用效果。方法选取我院2016年8月至2018年7月收治的恶性肿瘤晚期患者84例作为研究对象,随机将其分为两组:观察组(n=42)和对照组(n=42)。对照组采用常规的护理措施,观察组患者采取安宁疗护。分别在干预前后采有视觉模拟评分法(VAS)、焦虑自评量表(SAS)、抑郁自评量表(SDS)、SF-36生存质量量表评价两组的疼痛、不良情绪及生活质量。结果与干预前比较,两组护理后VAS、SAS以及SDS评分均明显降低,差异有显著性(P<0.05)。与对照组护理后比较,观察组护理后VAS、SAS以及SDS评分降低显著,差异有显著性(P<0.05)。与对照组比较,观察组患者护理后生理功能、社会功能、躯体疼痛、情感职能以及精神健康评分均明显升高,差异有显著性(P<0.05)。结论安宁疗护可以明显减轻恶性肿瘤晚期患者的疼痛程度,改善其不良情绪,提高其生活质量,临床广泛应用的价值较高。     

基于尊严疗法的安宁疗护在肺癌晚期患者中的应用

目的：探讨基于尊严疗法的安宁疗护在肺癌晚期患者中的应用效果。方法：选取2020年5月1日～2021年5月31日南京医科大学附属无锡人民医院肿瘤科收治的102例肺癌晚期患者，入院后均进行编号，采用单双号法分为对照组和观察组各51例，对照组采用常规安宁疗护，观察组采用基于尊严疗法的安宁疗护；比较两组死亡态度，干预前后焦虑和抑郁程度[采用汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)]、自尊状况[采用罗森伯格自尊量表(SES)]、幸福感[采用纽芬兰大学幸福度量表(MUNSH)]及生活质量[采用癌症患者生活质量测定量表((QLQ-C30)]。结果：观察组死亡接受度高于对照组(P<0.05);干预后，两组HAMA、HAMD评分均低于干预前(P<0.05),且观察组低于对照组(P<0.01);干预后，两组SES、MUNSH评分均高于干预前(P<0.05),且观察组高于对照组(P<0.01);干预后，两组QLQ-C30中认知、情绪、躯体、角色、社会维度得分及总分均高于干预前(P<0.05),且观察组高于对照组(P<0.05)。结论：将基于尊严疗法的安...     

安宁疗护对晚期乳腺癌患者心理弹性、心理应激及生存质量的影响

目的:探讨安宁疗护对晚期乳腺癌患者心理弹性、心理应激及生存质量的影响。方法:选择2018年3月1日～2020年2月29日就诊的98例晚期乳腺癌患者为研究对象。按照随机数字表法将患者分为观察组和对照组各49例,对照组给予常规治疗和护理,观察组在对照组基础上应用安宁疗护模式进行干预。比较两组干预前后心理弹性[采用改良心理弹性量表(CD-RISC)]、心理应激[采用抑郁-焦虑-压力自评量表(DASS-21)]、自我感受负担[采用自我感受负担量表(SPBS)]、主观幸福感[采用总体幸福感量表(GWB)]、生存质量[采用乳腺癌患者生命质量测定量表(QLQ-BR53)]。结果:干预后,两组CD-RISC中坚韧、力量、乐观评分及总分与GWB各维度评分及总分均高于干预前(P0.05),且观察组高于对照组(P0.05);干预后,两组DASS-21中焦虑、抑郁、压力评分及总分与SPBS中身体、情感、经济评分及总分均低于干预前(P0.05),且观察组低于对照组(P0.05);干预后,观察组QLQ-BR53评分低于对照组(P0.01)。结论:安宁疗护可提升晚期乳腺癌患者的心理弹性水平,缓解心理应激反应,减轻自我感受负担,对患者主观幸福感和生活质量水平均起到积极影响。     

基于多学科协作的安宁疗护在晚期癌症患者中的应用

目的 评价基于多学科协作的安宁疗护在晚期癌症患者中的应用价值。方法 选取福建省肿瘤医院2020年1月至2022年5月收治的共计100例晚期癌症患者为研究对象,按简单随机抽样法分为对照组和观察组,2组各50例。对照组接受常规护理,观察组接受基于多学科协作的安宁疗护。比较2组的疼痛程度、癌因性疲乏及生命质量。结果 与干预前的疼痛数字评分法和中文版简易疲乏量表评分对比,2组在干预1个月后、干预2个月后及出院时的上述评分均降低(P均<0.05),且观察组均低于同期对照组(P均<0.05)。干预1个月后和出院时,2组癌症患者生命质量测定量表的4个维度评分均较干预前改善(P均<0.05),且观察组均优于对照组(P均<0.05)。结论 基于多学科协作的安宁疗护对晚期癌症患者疼痛和癌因性疲乏的减轻,以及生命质量的提升均有积极作用。     

The ‘dark side’ of adjuvant analgesic drugs

Background: Both life expectancy and rates of cancer death increase in Korea, and quality of life is increasingly recognised as an important issue for cancer patients. Despite the developments of early diagnosis and treatments for cancer, increased medical costs have became a major problem for families and for governments. This study assessed the medical costs and the quality of life in terminal cancer patients in various care facilities to assess the contribution of hospice care to the maintenance of quality of life and to cost reduction.

Methods: A total of 159 patients (male: 70, female: 89) with terminal cancer were entered into the study. Their care was managed in four types of care facility (home hospice, charity hospital hospice unit, university hospital hospice unit, university hospital non-hospice unit) between November 1 1997 and January 31 1999. Differences in medical costs and quality of life (pain, depression, ADLs, family APGAR score) were assessed during the last 1 week of life in these facilities, analysed by one-way ANOVA test.

Results: Mean costs of the medical care during the last week of life was US$ 54.4 in the charity hospital hospice unit, US$ 87.6 in the home hospice, US$ 585.1 in the university hospital hospice unit, and US$ 864.5 in the university hospital non-hospice unit. ADL scores for patient in the home hospice were lower than those of other medical facilities (p<0.001). Pain scores on the dying day and one day before death were lowest in the home hospice and university hospital hospice (p<0.01). No differences were noted in depression scales or family APGAR scores.

Conclusion: In Korea, where much charitable and volunteer effort maintains hospice programmes, the cost of hospice care is less than that of the non-hospice care. Patients of home hospice, even with low ADLs, experienced less pain and had measures of psychological and family functioning score during the last days of life no less than in other settings. Hospice approaches to care deserve greater recognition and official support in Korea.     

一核多元团队照护模式在免疫肿瘤治疗进展期肺癌患者安宁疗护中的应用

目的:探讨一核多元团队照护模式在免疫肿瘤治疗进展期肺癌患者安宁疗护中的应用效果.方法:将2017年8月1日～2020年10月1日收治的100例行免疫治疗的肺癌患者,随机分为对照组和观察组各50例;对照组实施常规护理干预,研究组实施一核多元团队照护模式;比较两组负性情绪[采用焦虑自评量表(SAS)、抑郁自评量表(SDS)...     

肝癌晚期大量腹水患者的舒适护理

目的:探讨对肝癌晚期大量腹水患者实施舒适护理的方法。方法:对80例肝癌晚期大量腹水患者给予一系列舒适护理措施。结果:本组患者睡眠情况改善68例,有效率85%;进食改善48例,有效率60%;双下肢水肿、渗液症状改善42例,有效率52.5%;腹胀缓解改善53例,有效率66.3%。结论:对肝癌晚期大量腹水患者实施舒适护理可提高患者治疗信心,促进症状缓解,减少并发症的发生,提高患者的舒适度及生存质量,值得临床推广。     

Factors associated with the accuracy of family caregiver estimates of patient pain.

This study identified factors associated with inaccurate family caregiver assessments of patient pain. Participants were 31 caregiver-patient dyads receiving hospice home care. All patients had a primary diagnosis of end-stage cancer. As expected, caregivers overestimated patient pain. The degree of disparity for each dyad was calculated by subtracting the patient's pain rating from the caregiver's rating of patient pain. Caregiver knowledge of cancer pain management was not related to the degree of disparity in pain ratings, but caregivers' experience of patient pain was significantly related to accuracy of caregivers' pain ratings. Those caregivers who 1) perceived their loved one to be in a great deal of distress secondary to pain, 2) associated greater efforts at pain relief (i.e., more medication) with greater levels of pain, and 3) were themselves distressed by the patient's pain had the most inaccurate estimates of patient pain. There was a trend for greater disparity in pain estimates to be related to poorer existential quality of life for patients. Overall, the findings suggest that health care providers need to take into consideration family members' interpretation of patient pain when providing pain management education services.     

A model of palliative care: the palliative medicine program of the Cleveland Clinic Foundation

 Patients with advanced diseases, both cancer and noncancer, experience high symptom prevalence and psychosocial distress. Multiple unmet needs in the physical, psychosocial and spiritual domains are common. In the United States, palliative medicine is an emerging discipline that focuses on meeting these needs to achieve optimal quality of life for the patient–family unit. The majority of palliative care programs in the U.S. are consultation based. In contrast, the Palliative Medicine Program of the Cleveland Clinic Foundation offers multidisciplinary, comprehensive care from a primary or a consultative focus. The program has clinical, research, and educational components. Established as a consultation service in 1987, the clinical component now includes inpatient and outpatient consultation services, a dedicated acute care inpatient hospital unit, outpatient palliative medicine and cancer pain clinics, palliative home care, hospice home care and hospice residential care. Over 800 new patient consultations took place in 1997. In this paper, development of the program and its structure are described. Challenges to effective communication in a large program within a tertiary care institution are discussed, and strategies designed to meet these challenges are presented. Published online: 29 May 2000     

Simultaneous care: a model approach to the perceived conflict between investigational therapy and palliative care

Clinical trials of investigational therapy in patients with advanced cancer may not pay sufficient attention to quality of life (QOL) and supportive care issues, resulting in an adverse impact on the quality of care (QOC). We hypothesized that the simultaneous delivery of investigational therapy and a structured program of supportive care would result in measurable improvements in predefined outcomes without adverse events for patients, caregivers, or the physician/patient interaction. This report describes the findings of a trial designed to test the feasibility and initial results of such an approach. Forty-four patients accrued to Phase I or Phase II investigational therapy trials were simultaneously enrolled into a defined home care program focused on supportive care needs of the patient and family, as well as assessment of the toxicities of investigational therapy. These 44 patients constitute the Simultaneous Care (SC) cohort. Twenty patients receiving investigational therapy and the standard supportive care measures available through the Cancer Center served as a control group, designated the Usual Care (UC) cohort. We measured QOL using baseline and monthly assessments of the Functional Assessment of Cancer Therapy (FACT-G) instrument. This instrument measures four domains of well-being: physical, emotional, functional, and social/family. We prospectively defined QOC as: the percentage of hospice referrals; hospice length of stay; and number of cycles of chemotherapy administered. A summary score for the four FACT domains at each time point for each patient was calculated (FACT 4). The FACT 4 scores of the SC group improved compared to the UC group but did not reach a significant difference. Individual scores reflected a wide range of psychometric variability. A statistically significant difference in referral to hospice was seen in the SC group (35/44) compared to the UC group (8/15) (P = 0.034). The median length of stay in hospice was the same for both cohorts but the mean stay was greater in the SC cohort (54 days) compared to the UC cohort (37 days). The mean number of chemotherapy cycles was not different between SC and UC (P = 0.25). The self-reported acceptance by patients, caregivers, physicians and Cancer Center support staff was qualitatively excellent. Patients with advanced cancer at the time of enrollment onto investigational therapy should have made an explicit transition to palliative care goals but often have not. In the current health care environment, patients with advanced cancer without curative potential may be forced by their health provider or health insurer to choose between disease-directed therapy (including investigational therapy) or structured best supportive care programs. In this emerging era of targeted therapies, SC provides an approach designed to optimize palliative care goals while supporting the clinical research mission of offering patients with advanced cancer new and potentially better therapeutic interventions. SC is a system of care that enhances patient choice by allowing patients and families to have concurrent access to two beneficial options. SC may enhance coordination of care and facilitate patients' explicit transition from curative intent to palliative intent. In order to validate this approach, a randomized comparative trial evaluating SC has been initiated.     

安宁疗护对肿瘤晚期患者死亡认知态度及生活质量的影响

目的:探讨安宁疗护对肿瘤晚期患者死亡认知态度及生活质量的影响。方法:将2016年7月1日~2017年12月31日收治的57例肿瘤晚期患者作为对照组,给予常规护理干预;将2018年1月1日~2019年6月30日收治的57例肿瘤晚期患者作为研究组,给予安宁疗护。比较两组护理前、护理2个月主观幸福感[采用总体幸福感量表(GWB)]、睡眠质量[采用睡眠质量自评量表(SRSS)]、生活质量[采用生活质量核心量表(QLQ-30)]及死亡认知态度情况[采用死亡态度描绘修订表(DAP-R)],并记录护理期间患者不适症状。结果:护理2个月,两组GWB评分、SRSS评分、QLQ-30评分均优于护理前(P<0.05),且研究组优于对照组(P<0.05);护理2个月,研究组DAP-R中趋近导向、中性及逃离导向的死亡接受评分均优于对照组(P<0.05);研究组不适症状发生率低于对照组(P<0.05)。结论:对肿瘤晚期患者应用安宁疗护,不仅可有效改善患者死亡认知态度、睡眠质量,还能提升其主观幸福感和生活质量,减轻患者不适症状。     

Analyses of nursing home residents in hospice care using the minimum data set

OBJECTIVE: To present comprehensive profiles of residents in hospice care at admission to the nursing home using the Minimum Data Set (MDS). DESIGN AND SETTING: We analysed 40,622 MDS admission assessments for nursing home residents in hospice care. The MDS contains resident-focused data on pain, cognitive patterns, physical function, disease diagnoses, medications, nutrition, and specific treatments received. RESULTS: About four in five recently admitted hospice residents had 'do not resuscitate' orders and only 27% had a living will. Over 70% of recently admitted hospice residents experienced pain, with almost one half experiencing daily pain. Over one half of those hospice residents in pain experienced moderate pain and almost one third experienced horrible or excruciating pain. About 57% of recently admitted hospice patients had cancer, 21 % had congestive heart failure, 20% had emphysema/chronic obstructive pulmonary disease, and 18% had depression. About one in two recently admitted hospice residents exhibited at least moderate impairment in cognitive function. CONCLUSIONS: There is a need to improve pain management, advanced directives, and mental health services for residents dying in nursing homes.