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社区短期综合姑息和支持治疗可减轻慢性非癌症老年患者的症状困扰

2021-10-03 小文子 MedSci原创

姑息和支持治疗干预是减轻慢性非癌症老年患者症状困扰的一种有效且具有成本效益的方法。

越来越多的老年人患有多种慢性疾病,随病情进展,可能会导致老年人越来越痛苦。姑息治疗是以人为中心的综合治疗,旨在预防和减轻痛苦并提高患者及家庭成员的生活质量。癌症是国际姑息治疗的重点,而慢性非癌症患者的姑息治疗通常在疾病晚期才开始,而姑息治疗对慢性非癌症患者来说是有益的,因为它可减轻患者焦虑。

发表在International Journal of Nursing Studies杂志的一篇文章评估基于社区的短期综合姑息和支持治疗干预(SIPScare)对慢性非癌症和虚弱老年患者基线和12周之间症状变化的影响。并评估患者干预6周时症状,以及6周和12周时患者和护理人员的其他姑息治疗问题,评价SIPScare的成本效益和认知。

研究人员在英国4个国家卫生服务全科诊所,招募年龄≥75岁、中度至重度虚弱、慢性非癌症疾病且具有2种以上症状的患者,以及家庭护理人员(如可用)。由全科医生和社区护士合作的多学科姑息治疗团队提供的以患者为中心的综合姑息治疗。主要结局是从基线到12周姑息治疗后症状的变化。

50名患者随机分配接受常规治疗(n=26,平均年龄86.0岁)或姑息和常规治疗(n=24,平均年龄85.3岁),以及26名家庭护理人员(对照组n=16,平均年龄77.0岁;干预组n=10,平均年龄77.3岁)。患者住在家里(n=48)或养老院(n=2)。主要结局的完整病例分析(n=48)显示,干预组患者的症状困扰减轻,与对照组有差异(MD=-1.20,95%CI, -2.37至-0.027)。与常规治疗相比,干预组的症状困扰减轻,同时护理成本降低,证明了成本效益

结果表明,姑息和支持治疗干预是减轻慢性非癌症老年患者症状困扰的一种有效且具有成本效益的方法。对于患有慢性疾病的老年人,将姑息治疗与社区治疗相结合是一种临床有效的方法。进一步研究表明,应更广泛地检查在家庭和养老院中的实施情况。

原文出处:

Catherine J. Evans , Anna E. Bone,et al, Community-based short-term integrated palliative and supportive care reduces symptom distress for older people with chronic noncancer conditions compared with usual care: A randomised controlled single-blind mixed method trial, 2021, International Journal of Nursing Studies, https://doi.org/10.1016/j.ijnurstu.2021.103978

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    2022-09-02 sunyl07
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    2021-10-04 1019508837

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