| 赵文娟,张晓菊,黄喆,莫淼,江军仪,赵苇苇.晚期肿瘤患者首次转诊至安宁疗护科的时间调查及其影响因素分析[J].上海护理,2021,21(S1): |
| 晚期肿瘤患者首次转诊至安宁疗护科的时间调查及其影响因素分析 |
| Factors associated with first referral to palliative care unit among patients with advanced cancer |
| DOI： |
| 中文关键词: 晚期肿瘤患者 安宁疗护 首次就诊 影响因素 |
| 英文关键词:advanced cancer patients palliative care first referral factors |
| 基金项目:复旦大学复星护理科研基金，面上项目（FNF201827）；复旦大学附属肿瘤医院科研项目（HL201701） |
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| 中文摘要: |
| 目的：调查晚期肿瘤患者首次至安宁疗护科就诊距离其死亡的时间并分析患者特征对就诊时间的影响，为制定提高患者充分利用安宁疗护服务的策略提供依据。
方法：采用回顾性队列研究，对2013年7月1日到2015年10月30日首次至某三级肿瘤专科医院安宁疗护科就诊的患者进行随访至其死亡，计算患者首次至安宁疗护科就诊的日期距离其死亡日期的时间。采用二分类非条件logistic回归分析各因素对首次就诊至安宁疗护科的时间早晚的影响。
结果：310名患者纳入研究，平均年龄为64.3±12.6岁，患者首次就诊至死亡的中位时间为38天，133例（42.9%）患者为较晚就诊（距离死亡≤30天），177例（57.1%）患者为较早就诊（距离死亡＞30天）。随着文化程度的升高，就早就诊的比例会降低（趋势检验p＜0.05）；病程6个月及以上的患者就早转诊的比例是病程6个月以内患者的1.72倍（95%CI：1.087-2.724）。性别、年龄、籍贯、有无配偶、肿瘤分类、是否合并基础疾病、是否有肿瘤家族史对首次就诊时间早晚影响无统计学意义（p＞0.05）。较晚就诊的患者自理能力更差（趋势检验p＜0.001），KPS评分更低（＜60分，OR=3.597，95%CI：2.241-5.772），营养风险比例更高（＜3分，OR=0.599，95%CI：0.376-0.956），出现胸腹水的比例更高（无胸腹水，OR=0.420，95%CI：0.254-0.695）。
结论：近半数的晚期肿瘤患者临终前一个月内才接受到安宁疗护服务，患者的文化程度、病程会影响首次就诊时间；而较晚就诊的患者总体身体状态更差。需要进一步研究改善晚期肿瘤患者首次至安宁疗护科就诊的策略，以充分利用安宁疗护服务，提高患者及家属的生活质量。 |
| 英文摘要: |
| Aim：To identify the duration of first hospice-based palliative care prior to death for advanced cancer patients in mainland China and explores influencing factors.
Methods：We conducted a retrospective cohort study , the patients who were first referred to the palliative care unit in a tertiary cancer hospital from July 1, 2013 to October 30, 2015 were followed up. We conducted the date between first referral to death, used the binary unconditional logistic regression to analyze the influential factors.
Results：Three hundred and ten patients were included in our analyses with an average age of 64.3±12.6 years, 133 patients (42.9%) were late referral(≤30days from death), and 177 (57.1%) were early referral(>30 days from death). The median time from referral to death was 38 days. As education level increases, the ratio of early referral will decrease (p<0.05); the ratio of early referral for patients with a disease course (≥ 6 months) is 1.72 times that of patients with a disease course （＜6 months） (95%CI: 1.087-2.724). Sex, age, residence, spouse, type of cancer, chronic condition, cancer family history did not differ based on time of referral. Late referral patients had worse self-care ability, lower KPS score, higher nutritional risk ratio, and higher proportion of pleural and ascites (p<0.05)
Conclusion：Our patients with advanced disease are receiving referrals to hospice specialist palliative care very late in their illness trajectory. Education and disease course persist as determinants of duration of palliative care before death, the overall physical condition of patients who were referred later is worse. Further research is needed to improve the strategy of referral of patients with advanced cancer to the palliative care unit and clarify the referral mechanism to make full use of palliative care services and improve the quality of life of patients and their families. |
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