心理干预对癌症患者家属负性情绪的影响

目的 探讨综合心理干预对癌症晚期患者家属焦虑抑郁情绪的影响.方法 将86例癌症晚期患者家属随机分为两组.对照组不进行干预,干预组进行团体心理治疗,采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评定其情绪状况,观察比较家属在综合心理干预8周前后SAS和SDS评分结果.结果 干预组患者家属焦虑情绪得到明显改善,前后比较有显著性差异(t=4.225,P＜0.001);干预组患者家属抑郁情绪得到明显改善,前后比较有显著性差异(t=4.345,P＜0.001).结论 综合心理干预可以改善癌症晚期患者家属的焦虑抑郁情绪.     

护理干预在ICU危重患者家属中的应用

目的探讨护理干预在改善ICU危重患者家属心理状况的作用。方法以82例ICU危重患者家属随机分为对照组和观察组,每组41例,对照组给予一般护理干预,观察组给予综合护理干预。结果接受护理干预后,观察组患者家属的焦虑情绪的改善状况明显优于对照组（P<0.01）,总满意率明显高于对照组（P<0.05）。结论通过对ICU危重患者家属实施有效的综合护理干预,从而减轻家属的焦虑程度,提高患者主动配合医护工作的积极性,具有重要的临床应用价值。     

晚期癌症患者家属生活质量现状与家庭功能的关系

目的:了解晚期癌症患者家属生活质量现状及其与家庭功能的关系。方法:采用家庭功能量表(FAD)和生存质量测定量表简表(WHOQOL-BRIEF)对174名晚期癌症患者家属进行调查。结果:晚期癌症患者男性家属生活质量高于女性家属(t=2.616,P0.05),患者身体状况不同的晚期癌症患者照顾者在生活质量总分存在显著差异(F=7.176,P0.01),不同患者病情知情程度的晚期癌症患者照顾者在生活质量总分存在显著差异(F=7.656,P0.01);不同FAD组生活质量差异有统计学意义(F=20.641,P0.001);家庭功能和生活质量总分表现出显著负相关(r=-0.456,P0.01)。结论:晚期癌症患者家属生活质量不容乐观,在性别、患者身体状况、患者病情知情程度方面的差异有统计学意义,并且家庭功能是影响生活质量的重要因素,不容忽视。     

晚期癌症患者护理

晚期癌症病人深受疾病的折磨,身心承受着极大的痛苦,全部病例均根据病情采用免疫、中医药、对症支持及放疗、化疗等治疗.三分治疗、七分护理.如何减轻晚期癌症病人的痛苦,让病人顺利度过生命的最后时期,延长其生命,是医护人员及家人面临的一项重要护理措施.     

舒适护理在癌症晚期患者中的应用

目的：探讨舒适护理模式癌症晚期患者护理中的应用及效果。方法将120例癌症晚期患者随机分为舒适研究护理组和普通对照护理组60例,对照组采用常规护理,研究组依据患者情况实施舒适护理,观察前后两组患者生活质量情况。舒适护理组患者生活质量状态评分高于对照组,差异有统计学意义(P<0.05)。结论对晚期的癌症患者开展舒适护理模式,可减轻患者的疼痛,缓解患者的心理抑郁,极大地提高患者的生活质量,显著提高预生存期。     

50例晚期癌症患者及家属对安乐死态度的调查

５０例晚期癌症患者及家属对安乐死态度的调查天津解放军二七二医院仝占堂张民杨和平张继红龚开毅齐万计目前认同安乐死的人越来越多，但在法学、伦理学、哲学和社会学等方面还存有争议，为了弄清癌症患者病重病危时对安乐死的态度，我们对１９９４年５月至１９９６年６月...     

癌症晚期患者的疼痛临床护理对策分析

目的评估癌症晚期患者的疼痛情况,分析癌症晚期患者的疼痛临床护理对策,以求减少患者的疼痛。方法收集我院2011年3月~2014年3月收治的50例癌症晚期患者,随机分为对照组和观察组,各25例。对50例患者进行了疼痛评估,对照组采取传统的护理模式进行护理,观察组在对照组的基础上,给予针对性优质护理干预,观察比较两组患者的临床效果。结果癌症晚期患者以疼痛为主要症状,经过治疗两组患者的疼痛情况均有所缓解,但观察组的总有效率明显高于对照组(P<0.05),差异具有统计学意义。结论实施针对性优质护理干预对癌症晚期患者的疼痛具有明显的缓解作用,在癌症晚期患者的治疗中起到了关键作用。     

癌症患者病故对家属情绪状态的影响

目的　探讨癌症患者病故对家属情绪状态的影响。方法　对癌症患者病故的家属共 79人进行问卷随机调查 ,采用焦虑自评量表 ((SAS)、抑郁自评量表 (SDS)和 UCLA孤独量表测量其家属的情绪状态。结果　 1当癌症患者病故其配偶的焦虑、抑郁和孤独情绪明显高于其子女 (P<0 .0 5 ) ;2配偶与子女相比在不同程度的抑郁构成百分比有显著差异 (P<0 .0 5 ) ,在配偶中重度抑郁 2 7人 (62 .8% ) ;3不同性别配偶其情绪状态相比无显著性差异 (P>0 .0 5 ) ;4高龄组配偶的抑郁和孤独情绪明显高于低龄组配偶 (P<0 .0 5 ) ;5在不同性别子女中 ,女性的焦虑和抑郁情绪明显高于男性 (P<0 .0 5 ) ;6子女中高龄组的焦虑情绪明显高于低龄组 (P<0 .0 5 )。结论　癌症患者去世后 ,其家属存在的负性情绪明显 ,应引起社会的关注 ,对于配偶、特别是老年配偶和女性子女等应给予有效地心理、社会支持 ,有利于提高他们的生存质量。     

50例癌症患者家属的焦虑心理分析

本文通过对５０例癌症患者家属的调查,了解到家属在患者发病不同阶段的焦虑心理的变化程度,发不同家属的不同态度和行为对病人的活动和预后至关重要,提示在病人发病不同时期应对家属进行相对应的护理。     

浅谈恶性肿瘤患者及其家属的心理护理与干预措施

目的探讨对恶性肿瘤患者及其患者家属采取心理护理干预措施,提高其生存质量的方法。方法与结果分析恶性肿瘤及其家属的心理特征,采取相应的护理干预措施,及时解决患者存在的心理问题,使患者树立战胜疾病的信心,使家属对癌症有比较正确的认识,祛除癌症不可治观点,帮助家属树立正确的态度对待患者的疾病,做好陪护工作。结论心理护理干预措施能有效改善患者及其家属的负面心理,提高患者及其家属的生活质量。     

The comparison of common cancer types and the coincidence of concomitant chronic diseases between palliative home care patients in Lodz Voivodeship and the general Polish population

Introduction

The continued growth in the number of elderly with cancer and age-related chronic diseases will cause in Poland an increase in demand for palliative care. The aim of the study was to identify chronic comorbidities and cancer types in palliative home care patients and to compare their incidence with the general Polish population.

Material and methods

The data was obtained from 543 patients who received palliative home care between 2005-2009. The occurrence of the most common chronic conditions such as arterial hypertension, ischemic heart disease, diabetes, chronic pulmonary diseases and central nervous system diseases were analysed together with the cancer types.

Results

The study group included 259 women (47.7%) and 284 men (52.3%) aged 25-91 years old. The most common primary neoplasm locations for men were lung (28.2% vs. 21.4% in general population) and colorectal cancer (18.7% vs. 11.4% in general population), and in women breast (19.7% vs. 22.8% in general population) and colorectal cancer (17.4% vs. 9.2% in general population). The incidence of ischemic heart disease, diabetes, and chronic pulmonary diseases was significantly different in comparison to the general populations (47.0% vs. 11.3%; 20.3% vs. 6.8%; 16.6% vs. 27.5%, respectively). The mean number of concomitant diseases was 1.6 for women and 1.8 for men vs. 1.7 and 1.2 in the general Polish population respectively.

Conclusions

The majority of the patients had concomitant disease, with cardiovascular diseases being most common. The most common primary neoplasm diagnoses in palliative home care patients were lung and colorectal cancer, which corresponds to the cancer prevalence in the general population.     

Associations between home death and GP involvement in palliative cancer care

Background

Most cancer patients die at institutions despite their wish for home death. GP-related factors may be crucial in attaining home death.

Aim

To describe cancer patients in palliative care at home and examine associations between home death and GP involvement in the palliative pathway.

Design of study

Population-based, combined register and questionnaire study.

Setting

Aarhus County, Denmark.

Method

Patient-specific questionnaires were sent to GPs of 599 cancer patients who died during a 9-month period in 2006. The 333 cases that were included comprised information on sociodemography and GP-related issues; for example knowledge of the patient, unplanned home visits, GPs providing their private phone number, and contact with relatives. Register data were collected on patients'' age, sex, cancer diagnosis, place of death, and number of GP home visits. Associations with home death were analysed in a multivariable regression model with prevalence ratios (PR) as a measure of association.

Results

There was a strong association between facilitating home death and GPs making home visits (PR = 4.3, 95% confidence interval [CI] = 1.2 to 14.9) and involvement of community nurses (PR = 1.4, 95% CI = 1.0 to 1.9). No other GP-related variables were statistically significantly associated with home death.

Conclusion

Active involvement of GPs providing home visits and the use of home nurses were independently associated with a higher likelihood of facilitating home death for cancer patients. The primary care team may facilitate home death, accommodating patients'' wishes. Future research should examine the precise mechanisms of their involvement.     

Palliative care for elderly patients with advanced cancer: a long-term intervention for end-of-life care

OBJECTIVE: This essay identifies elderly cancer patients as a population that experiences cancer-related health disparities at the end-of-life. METHODS: While hospice and palliative care (PC) are care options for this population, it is argued that PC prior to hospice will yield numerous benefits for long-term end-of-life care. RESULTS: It is theorized that PC prior to hospice will be beneficial in meeting the family's needs in a timely and adequate manner, improving quality of life, increasing caregiver satisfaction and communication, possibly delay institutionalization of the patient, and may ultimately impact bereavement. CONCLUSION: Patients would be able to benefit from PC in an early stage of their disease, positively influencing older cancer patients and families. PRACTICE IMPLICATIONS: Long-term assessment of the impact of PC prior to hospice is proposed as a promising direction of future research.     

Advance care planning for cancer patients in primary care: a feasibility study

Background

Advance care planning is being promoted as a central component of end-of-life policies in many developed countries, but there is concern that professionals find its implementation challenging.

Aim

To assess the feasibility of implementing advance care planning in UK primary care.

Design of study

Mixed methods evaluation of a pilot educational intervention.

Setting

Four general practices in south-east Scotland.

Method

Interviews with 20 GPs and eight community nurses before and after a practice-based workshop; this was followed by telephone interviews with nine other GPs with a special interest in palliative care from across the UK.

Results

End-of-life care planning for patients typically starts as an urgent response to clear evidence of a short prognosis, and aims to achieve a ‘good death’. Findings suggest that there were multiple barriers to earlier planning: prognostic uncertainty; limited collaboration with secondary care; a desire to maintain hope; and resistance to any kind of ‘tick-box’ approach. Following the workshop, participants'' knowledge and skills were enhanced but there was little evidence of more proactive planning. GPs from other parts of the UK described confusion over terminology and were concerned about the difficulties of implementing inflexible, policy-driven care.

Conclusion

A clear divide was found between UK policy directives and delivery of end-of-life care in the community that educational interventions targeting primary care professionals are unlikely to address. Advance care planning has the potential to promote autonomy and shared decision making about end-of-life care, but this will require a significant shift in attitudes.     

正念干预对癌症患者创伤后成长干预效果的meta分析

目的:评价正念干预(MBI)对癌症患者创伤后成长(PTG)的干预效果。方法:计算机检索Cochrane library、PubMed、Embase、Web of Science、CBM、VIP、WangFang Data和CNKI数据库中MBI对癌症患者PTG的随机对照试验(RCT)。两名研究者按照纳入排除标准独立筛选文献、进行文献质量评价并从中提取数据,采用RevMan 5.3软件进行数据分析。结果:共纳入9篇RCT,合计822例患者。Meta分析结果显示,实施MBI后,干预组患者的PTG水平优于对照组,差异有统计学意义[MD=7.27,95%CI=(4.75~9.79),P<0.001],干预效果能维持到干预后3个月[MD=8.64,95%CI=(7.20~10.08),P<0.001]。与对照组相比,线上干预模式对癌症患者PTG的改善效果不明显,差异无统计学意义[MD=3.59,95%CI=(-1.22~8.41),P>0.05],而面对面的小组干预模式能促进癌症患者PTG水平的提高[MD=7.87,95%CI=(5.19~10.54),P<0.001]。结论:正念干预有助于提高癌症患者的创伤后成长水平,面对面小组干预模式比线上干预模式在提升患者的创伤后成长水平上效果更佳。     

The power of clinician-expressed empathy to increase information recall in advanced breast cancer care: an observational study in clinical care,exploring the mediating role of anxiety

ObjectiveExperimental studies have found that clinician-expressed empathy improves patients’ information recall in (advanced) cancer consultations. It remains unclear, however, whether these results are generalizable to clinical care and, if so, what the underlying mechanism is. We aimed to i) determine the relationship between clinician-expressed empathy and patients’ information recall in clinical advanced breast cancer consultations; and ii) test whether the relationship between clinician-expressed empathy and recall is mediated by a decrease in patients’ anxiety.MethodsForty-one consultations between oncologists and female patients with advanced breast cancer were audio recorded. Patients’ post-consultation information recall and pre- and post-consultation anxiety (0-100) were assessed. Recall was scored according to a self-created questionnaire. Clinician-expressed empathy (0-100) was assessed by observers. Structural Equation Modelling was used for all analyses.ResultsParticipants remembered 61% of the information discussed. Clinician-expressed empathy significantly increased patients’ total information recall (p = .041) and recall of treatment aims/positive effects (p = .028). The mediating role of anxiety could not be established.ConclusionAlthough the underlying mechanism remains unclear, clinicians have a powerful tool to improve seriously ill breast cancer patients’ recall of information: empathy.Practice implicationsThese insights should encourage clinicians to express empathy; practical communication training might prove helpful.     

Improving patient knowledge of palliative care: A randomized controlled intervention study

ObjectivesTo determine if laypersons’ knowledge about palliative care can improve with a brief education intervention.Methods152 adults were recruited to participate in a web-based randomized intervention trial that followed a 2 (content) × 2 (format) between-subjects design. Groups received either a video intervention, an information page intervention, a video control, or an information page control. An ANCOVA with contrast coding of two factors was utilized to assess if knowledge, as measured by the Palliative Care Knowledge Scale (PaCKS), increased post intervention.ResultsThere was a significant difference between intervention group means and control group means on PaCKS scores from T1 to T2 F(1, 139) = 11.10, p = 0.00, η_p² = 0.074. There was no significant difference in PaCKS change scores between the video intervention and information page intervention.ConclusionsThis study demonstrates that an information page and a brief video can improve knowledge of palliative care in laypersons.Practice implicationsSelf-administered educational interventions could be made available in diverse settings in order to reach patients and their families who may benefit from but are unaware of palliative care. Interventions more intensive than the one tested in this study might result in even more significant improvements in knowledge.     

Dysfunctional and short-lived subsets in monocyte-derived dendritic cells from patients with advanced cancer

Dendritic cells (DCs) are antigen-presenting cells specialized for the induction of the primary T-cell response. Tumor immunotherapy using DCs loaded with tumor antigens is under way for patients with several types of advanced malignancies. In this study, DC-like cells (Mo-DCs) were generated from peripheral blood monocytes with granulocyte-macrophage colony-stimulating factor and interleukin-4. The antigen-presenting abilities, including capture of apoptotic tumor cells, IL-12 secretion, expression of antigen-presentation-related molecules (HLA-ABC, HLA-DR, and CD80), and mixed leukocyte reaction, of Mo-DCs from 37 patients with advanced cancer (pMo-DCs) were compared to those of 20 healthy volunteers (hMo-DCs). Seven days after the initial culture, no significant difference was found in either the number or the size of Mo-DC-forming colonies between the two groups. However, most of the antigen-presenting abilities of pMo-DCs were weaker than those of hMo-DCs on day 7. On day 14, both number and size of colonies were significantly decreased in pMo-DCs but not in hMo-DCs. Interestingly, the antigen-presenting abilities of the remaining pMo-DCs gradually strengthened with time and by day 14 no significant difference was observed between pMo-DCs and hMo-DCs. These results indicate that pMo-DCs contain dysfunctional and short-lived Mo-DC subsets.     

Judgements about fellow professionals and the management of patients receiving palliative care in primary care: a qualitative study.

BACKGROUND: Policies emphasise the importance of collaborative working in community palliative care. Collaborations are generally formed through formal and informal referral processes, but little is known about what influences professionals' decisions to refer to such services. AIM: To explore the influences on referrals within general and specialist community palliative care services. DESIGN OF STUDY: Qualitative, multiple-case study. SETTING: Three primary care trusts in the north-west of England. METHOD: Multiple data collection methods were employed, including documentary analysis, observation of referral team meetings and interviews. This paper primarily reports data from interviews with 47 health professionals, including GPs, district nurses, and specialist palliative care professionals. RESULTS: Judgements -- positive and negative -- about aspects of fellow professionals' performances appeared to influence referral decisions and ongoing collaboration and care. Attributes upon which these judgements were based included professional responsiveness and communication, respect, working and workload management practices, perceived expertise, and notions of elite practice. The effects of such judgements on referral and healthcare practices were altered by professional "game playing" to achieve professionals' desired outcomes. CONCLUSION: Palliative care policies and protocols need to take account of these complex and subtle influences on referrals and collaboration. In particular, teamwork and partnership are encouraged within palliative care work, but critical judgements indicate that such partnerships may be difficult or fragile. It is likely that such judgemental attitudes and practices affect many aspects of primary care, not just palliative care.     

Impact of pain and palliative care services on patients

Background:

Palliative care has become an emerging need of the day as the existing health-care facilities play only a limited role in the care of the chronically ill in the society. Patients with terminal illness in most cases spend their lives in the community among their family and neighbors, so there is the need for a multi disciplinary team for their constant care. Volunteers are primary care givers who originate normally from the same locality with local knowledge and good public contact through which they can make significant contributions in a team work by bridging the gap between the patient community and outside world.

Aim:

The present study has been undertaken to analyze the impact of palliative care services on patients by considering 51 variables.

Materials and Methods:

The respondents of the study include 50 pain and palliative care patients selected at random from 15 palliative care units functioning in Ernakulam district. The analysis was made by using statistical techniques viz. weighted average method, Chi-square test, Friedman repeated measures analysis of variance on ranks and percentages.

Results:

The study revealed that the major benefit of palliative care to the patients is the reduction of pain to a considerable extent, which was unbearable for them earlier. Second, the hope of patients could be maintained or strengthened through palliative care treatment.

Conclusion:

It is understood that the services of the doctors and nurses are to be improved further by making available their services to all the palliative care patients in a uniform manner.