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Sharing His Warmth. 分享他的温暖
IF 2.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-01 Epub Date: 2024-09-26 DOI: 10.1089/jpm.2024.0345
Rob Ruff
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引用次数: 0
Outpatient Pediatric Palliative Care Development: Guidance on Building Sustainable Programs. 儿科姑息关怀门诊发展:建立可持续计划指南》。
IF 2.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-01 Epub Date: 2024-08-21 DOI: 10.1089/jpm.2024.0148
Casie James, Suraj Sarvode Mothi, Elissa G Miller, Erica C Kaye, Alexis Morvant, Caroline Stafford, Ashley K Autrey

Context: As pediatric palliative care (PPC) expands within institutions and nationally, little guidance is available on building outpatient programs. Objectives: We asked outpatient PPC (OPPC) program leaders in the United States about clinic development experiences to gather advice for growing programs. Methods: As part of a larger OPPC study, 48 freestanding children's hospitals with inpatient PPC programs were invited to complete a survey on OPPC. Self-selected participants were sent a follow-up survey soliciting free-text responses about development experiences. Quantitative data were analyzed with descriptive statistics. Qualitative data underwent inductive content analysis. Results: Thirty-six hospitals completed the initial survey, and 28 (78%) reported practicing clinic-based OPPC. Twenty-two of 28 completed program development questions. More than half (12/22, 55%) recommended a minimum total billable full-time equivalent (FTE) ≥3 before expanding into the outpatient setting. About two-thirds (14/22, 64%) suggested a minimum billable FTE ≥4 for 24/7 coverage. Half (50%) reported that their program grew from subspecialty clinics, most frequently hematology-oncology (10/11, 91%). Half (50%) placed initial limits on referrals, with many restricting schedule availability (7/11, 64%). Six of 12 participants (50%) willing to share more about their development experience completed a follow-up survey, from which three themes emerged: program logistics, expectations and boundaries, and establishing role and workflow. Participants focused advice on slow programmatic growth to optimize sustainability. Conclusion: Program leaders offer tangible guidance informed by their OPPC development experience. Future work is needed to leverage this advice within institutions to promote resilient and sustainable PPC growth.

背景:随着儿科姑息关怀(PPC)在医疗机构和全国范围内的扩展,关于门诊项目建设的指导却少之又少。目标:我们向美国的门诊姑息关怀项目(OPPC)负责人询问了诊所的发展经验,为项目的发展收集建议。方法:作为一项大型 OPPC 研究的一部分,我们邀请了 48 家拥有 PPC 住院项目的独立儿童医院完成一项关于 OPPC 的调查。我们向自主选择的参与者发送了一份后续调查,征求他们对发展经验的自由文本回复。对定量数据进行了描述性统计分析。对定性数据进行归纳内容分析。结果:有 36 家医院完成了初步调查,其中 28 家(78%)报告说它们开展了以诊所为基础的 OPPC。28 家医院中有 22 家完成了项目开发问题。超过半数的医院(12/22,55%)建议在将业务扩展到门诊环境之前,至少要达到可收费全职当量(FTE)≥3。约三分之二(14/22,64%)的人建议,全天候服务的最低计费全职当量≥4。半数(50%)报告称,他们的项目是从亚专科诊所发展起来的,最常见的是血液肿瘤科(10/11,91%)。半数参与者(50%)对转诊进行了初步限制,其中许多人限制了时间安排(7/11,64%)。愿意分享更多发展经验的 12 位参与者中,有 6 位(50%)完成了后续调查,从中发现了三个主题:项目后勤、期望和界限,以及确立角色和工作流程。参与者主要建议计划缓慢增长,以优化可持续性。结论:计划领导者根据其 OPPC 的发展经验提供了切实可行的指导。今后需要开展工作,在各机构内利用这些建议,促进计划伙伴关系中心的弹性和可持续发展。
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引用次数: 0
Loneliness in Seriously Ill Nursing Home Residents During the COVID-19 Pandemic. COVID-19 大流行期间重病疗养院居民的孤独感。
IF 2.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-01 Epub Date: 2024-08-20 DOI: 10.1089/jpm.2024.0125
Vyjeyanthi S Periyakoil, Margery Bangoy, Dulce Rodriguez, Jon Fuller, Eric Neri, Helena Kraemer

Background: Loneliness and social isolation coexist, making it difficult to study each separately. The COVID-19 lockdown provided an unprecedented and ethically viable opportunity to study loneliness in seriously ill nursing home residents under uniformly imposed social isolation conditions. Objective: To understand the phenomenon of loneliness of the seriously ill nursing home patients under a uniform social isolation condition imposed by the COVID-19 pandemic lockdown. Design: Cross-sectional, semi-structured interviews were tape-recorded, transcribed verbatim, and analyzed qualitatively using an inductive thematic analysis. The University of California, Los Angeles (UCLA) Three-Item Loneliness Scale was used to measure loneliness and any relationships between self-reported loneliness and isolation were elucidated. Setting/Participants: Thirty seriously ill nursing home residents living in complete social isolation imposed by the COVID-19 pandemic lockdown. Results: Thematic analysis identified four key themes: (1) Diverse perceptions about the impact of the COVID-19 lockdown, (2) regret over the missed opportunities for spending time with friends and family, (3) using electronic communication to maintain connections with loved ones, and (4) the impact of nursing home staff. In total, 50% of the participants reported feeling socially isolated, 60% patients reported loneliness, and 70% reported being adversely impacted by the lockdown. Patients who felt socially isolated also reported experiencing loneliness (Kendall's Tau = 0.61, 95% confidence interval [CI] = 0.30, 0.89, p < 0.01, large effect size). Persons from communities of color had higher median loneliness scores compared to Non-Hispanic Whites. Participants in the last year of life also reported higher levels of loneliness. Conclusion: A study of loneliness under uniform social isolation conditions in seriously ill nursing home patients showed a high prevalence of loneliness and a strong correlation between self-reported loneliness and social isolation, especially in persons from minority communities and those in the last year of life. In-person support provided by nursing home staff and virtual support from family was helpful to patients.

背景:孤独与社会隔离同时存在,因此很难对两者分别进行研究。COVID-19 封锁行动为研究重症疗养院居民在统一的社会隔离条件下的孤独感提供了一个前所未有且符合伦理道德的机会。研究目的了解重症疗养院患者在 COVID-19 大流行封锁所施加的统一社会隔离条件下的孤独现象。设计:对横断面半结构式访谈进行录音、逐字转录,并采用归纳式主题分析法进行定性分析。采用加利福尼亚大学洛杉矶分校(UCLA)孤独感三项目量表来测量孤独感,并阐明自我报告的孤独感与隔离之间的关系。环境/参与者:30 名身患重病的疗养院居民,他们因 COVID-19 大流行病封锁而生活在完全与世隔绝的环境中。研究结果主题分析确定了四个关键主题:(1) 对 COVID-19 封锁影响的不同看法;(2) 错过与朋友和家人共度时光的遗憾;(3) 使用电子通信与亲人保持联系;(4) 疗养院工作人员的影响。总共有 50% 的参与者表示感到社交孤立,60% 的患者表示感到孤独,70% 的患者表示受到封锁的不利影响。感到社交孤立的患者也报告说经历了孤独感(Kendall's Tau = 0.61,95% 置信区间 [CI] = 0.30,0.89,P < 0.01,大效应)。与非西班牙裔白人相比,有色人种人群的孤独感中位数得分更高。生命最后一年的参与者也报告了较高的孤独感。结论一项针对疗养院重病患者在统一社会隔离条件下的孤独感的研究显示,孤独感的发生率很高,自我报告的孤独感与社会隔离之间存在很强的相关性,尤其是来自少数族裔社区和生命最后一年的患者。疗养院工作人员提供的亲身支持和家人提供的虚拟支持对病人很有帮助。
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引用次数: 0
Always and Forever. 永远不变
IF 2.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-01 Epub Date: 2024-06-25 DOI: 10.1089/jpm.2024.0202
Jennifer Eitingon
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引用次数: 0
Tele-Assisted Home-Based Palliative Care Reduces Health Care Costs for Terminal Cancer Patients: Real-World Evidence From a Regional Hospital in Taiwan. 远程协助居家姑息治疗可降低晚期癌症患者的医疗成本:来自台湾一家地区医院的真实证据。
IF 2.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-01 Epub Date: 2024-08-02 DOI: 10.1089/jpm.2023.0697
Chang-Sheng Jang, Jung-Der Wang, Hung-Pin Hou, Wu-Wei Lai, Li-Jung Elizabeth Ku

Background: Tele-assisted home-based palliative care (THPC) usually fulfills the desire of terminal patients to pass away at home. The overall costs of such a service deserve evaluation. Objectives: This study aims to determine health care utilization and costs for cancer patients at the end of life, stratified by THPC service. Design: Patients who received THPC were matched 1:1 based on age, gender, year of death, and propensity score with those who did not receive THPC. Setting/Subjects: A total of 773 cancer patients passed away in a regional hospital in Taiwan during the period of 2012-2020, of which 293 received THPC. Measurements: We measured the rates and costs of outpatient clinic visits, emergency department (ED) visits, hospitalizations, and intensive care unit (ICU) admissions during the last week, the last two weeks and the last month before death. In addition, we estimated the driving times and expenses required for transportation from each cancer patient's home to the hospital using Google Maps. National Health Insurance (NHI) reimbursements and out-of-pocket expenses were also calculated. Results: In comparison with patients without THPC, those who received THPC had a 50% lower likelihood of visiting the ED or being hospitalized, a more than 90% reduced chance of ICU admission, but were four times more likely to obtain their medicines from outpatient clinics. THPC patients had similar out-of-pocket expenditures, approximately half of the NHI costs, and lower rates and costs for ambulance transportation to the ED. Conclusions: THPC reduced health care costs for terminal cancer patients in the last week, the last two weeks, and the last month before death, while also increasing the likelihood of patients being able to rest and pass away at home.

背景:远程协助的居家姑息治疗(THPC)通常能满足晚期病人在家中去世的愿望。这种服务的总体成本值得评估。研究目的本研究旨在确定癌症患者在生命末期的医疗保健使用情况和成本,并根据 THPC 服务进行分层。设计:根据年龄、性别、死亡年份和倾向得分,将接受 THPC 的患者与未接受 THPC 的患者进行 1:1 匹配。设置/受试者:2012-2020 年间,台湾某地区医院共有 773 名癌症患者去世,其中 293 人接受了 THPC 治疗。测量:我们测量了死亡前最后一周、最后两周和最后一个月的门诊就诊率、急诊室就诊率、住院率和重症监护室入院率及费用。此外,我们还使用谷歌地图估算了每位癌症患者从家到医院所需的驾车时间和交通费用。我们还计算了国民健康保险(NHI)的报销额度和自付费用。结果显示与未接受 THPC 的患者相比,接受 THPC 的患者前往急诊室或住院的几率降低了 50%,入住重症监护室的几率降低了 90% 以上,但从门诊获取药物的几率却高出四倍。THPC 患者的自付费用相似,约为国家医疗保险费用的一半,救护车送往急诊室的比例和费用也较低。结论临终关怀方案降低了癌症晚期患者在死亡前最后一周、最后两周和最后一个月的医疗费用,同时也增加了患者在家休息和去世的可能性。
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引用次数: 0
If EQ-5D-5L Mobility Dimension Ratings Are High, Is Life-Space Assessment a Clinically Sensible Next Step? Data from a Population Survey. 如果 EQ-5D-5L 移动性维度评分很高,那么生活空间评估是否是临床上合理的下一步?来自人口调查的数据。
IF 2.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-01 Epub Date: 2024-10-04 DOI: 10.1089/jpm.2024.0193
Slavica Kochovska, Sungwon Chang, Jane L Phillips, David C Currow

Background: Impaired health states can limit a person's mobility, often progressively for people with life-limiting illnesses. Quantifying mobility changes is crucial for individual clinical care and service planning. Objective: To explore any correlation between EQ-5D-5L's mobility dimension ratings and Life-Space Assessment (LSA) from a population sample. Methods: An online population survey of Australian adults, nationally-representative by key demographics. An analysis of variance examined each level of the EQ-5D-5L mobility dimension rating against its LSA scores; Kendall's Tau assessed correlation. Results: Participants (n = 6366) were 53% women, mean age 46.1 years (SD 18.6), and mean LSA score 78.0 (SD = 27.5; possible range 0-120). At each EQ-5D-5L mobility dimension level there was a significant difference between LSA scores (p < 0.001), and a moderate negative correlation (Kendall's tau b = -0.342) between the two measures. Conclusion: Given the relationship defined, EQ-5D-5L mobility dimension ratings may prompt clinicians to consider further evaluation with the more detailed Life-Space Assessment. .

背景:健康受损会限制人的行动能力,对于患有局限生命的疾病的人来说,这种限制往往是渐进的。量化行动能力的变化对个人临床护理和服务规划至关重要。研究目的从人口样本中探讨 EQ-5D-5L 的行动能力维度评分与生命空间评估(LSA)之间的相关性。方法:对澳大利亚成年人进行在线人口调查:对澳大利亚成年人进行在线人口调查,主要人口统计数据在全国范围内具有代表性。方差分析研究了 EQ-5D-5L 移动能力维度评级的各个级别与 LSA 分数之间的关系;Kendall's Tau 评估了相关性。结果参与者(n = 6366)中 53% 为女性,平均年龄 46.1 岁(SD 18.6),平均 LSA 得分 78.0(SD = 27.5;可能范围 0-120)。在每个 EQ-5D-5L 移动能力维度水平上,LSA 分数之间都存在显著差异(p < 0.001),并且这两个测量值之间存在中度负相关(Kendall's tau b = -0.342)。结论鉴于所定义的关系,EQ-5D-5L 移动性维度评分可能会促使临床医生考虑使用更详细的生命空间评估进行进一步评估。.
{"title":"If EQ-5D-5L <i>Mobility Dimension</i> Ratings Are High, Is Life-Space Assessment a Clinically Sensible Next Step? Data from a Population Survey.","authors":"Slavica Kochovska, Sungwon Chang, Jane L Phillips, David C Currow","doi":"10.1089/jpm.2024.0193","DOIUrl":"10.1089/jpm.2024.0193","url":null,"abstract":"<p><p><b><i>Background:</i></b> Impaired health states can limit a person's mobility, often progressively for people with life-limiting illnesses. Quantifying mobility changes is crucial for individual clinical care and service planning. <b><i>Objective:</i></b> To explore any correlation between EQ-5D-5L's <i>mobility dimension</i> ratings and Life-Space Assessment (LSA) from a population sample. <b><i>Methods:</i></b> An online population survey of Australian adults, nationally-representative by key demographics. An analysis of variance examined each level of the EQ-5D-5L <i>mobility dimension</i> rating against its LSA scores; Kendall's Tau assessed correlation. <b><i>Results:</i></b> Participants (<i>n</i> = 6366) were 53% women, mean age 46.1 years (SD 18.6), and mean LSA score 78.0 (SD = 27.5; possible range 0-120). At each EQ-5D-5L <i>mobility dimension</i> level there was a significant difference between LSA scores (<i>p</i> < 0.001), and a moderate negative correlation (Kendall's tau b = -0.342) between the two measures. <b><i>Conclusion:</i></b> Given the relationship defined, EQ-5D-5L <i>mobility dimension</i> ratings may prompt clinicians to consider further evaluation with the more detailed Life-Space Assessment. .</p>","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1527-1530"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Call Me Maybe: What Do We still Need To Learn About Telepalliative Care? 也许会打电话给我关于远程姑息关怀,我们还需要了解什么?
IF 2.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-01 Epub Date: 2024-10-02 DOI: 10.1089/jpm.2024.0373
Mollie A Biewald, Robert Arnold
{"title":"Call Me Maybe: What Do We still Need To Learn About Telepalliative Care?","authors":"Mollie A Biewald, Robert Arnold","doi":"10.1089/jpm.2024.0373","DOIUrl":"10.1089/jpm.2024.0373","url":null,"abstract":"","PeriodicalId":16656,"journal":{"name":"Journal of palliative medicine","volume":" ","pages":"1432-1434"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Quality of Life and Clinical Outcomes of Endosonography-Guided Biliary Drainage in Patients with Malignant Biliary Obstruction: A Single-Center, Prospective Analysis. 恶性胆道梗阻患者在内镜引导下进行胆道引流的生活质量和临床疗效:单中心前瞻性分析
IF 2.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-01 Epub Date: 2024-08-02 DOI: 10.1089/jpm.2024.0084
Łukasz Krupa, Wiktor Smyk, Robert Staron, Edyta Niemiec, Anna Jadwisiak, Piotr Milkiewicz, Michał Żorniak, Marcin Krawczyk

Introduction: Endosonography-guided biliary drainage (EUS-BD) serves as a rescue treatment modality for patients with malignant biliary obstruction when endoscopic retrograde cholangiopancreatography (ERCP) fails. Objectives: This study explores the effects of EUS-BD on liver function and quality of life (QoL). Patients and Methods: Patients with malignant biliary obstruction and failed ERCP were enrolled to undergo EUS-BD. QoL, including pruritus severity, was evaluated using EQ-5D-5L and PSS-10 questionnaires before and after EUS-BD. Serum bilirubin and liver function tests were measured on the procedure day, two days, and at least 14 days post-procedure. Results: During a 20-month study period, 1755 ERCPs were performed, with 595 for malignant cases. Of these, 49 underwent EUS-BD following failed ERCP, and 37 (54% women, age range 34-87 years) completed the 14-day follow-up. Pancreatic cancer was the most common (49%) condition, and the median hospital stay was 4 days. Serum bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyl transferase significantly decreased 2 and 14 days after EUS-BD (all p < 0.001). Pruritus significantly improved, with an average reduction of 5.19 points on the PSS-10 scale two weeks post-procedure (p < 0.001). EUS-BD led to improvements in anxiety and depression according to the EQ-5D-5L (p = 0.013). Conversely, deteriorations were observed in the Mobility, Self-Care, and Usual Activities domains over time (all p < 0.05). Successful EUS-BD enabled the resumption of chemotherapy in 11 (30%) patients. The median post-procedure survival was 112 (range 27-1030) days. Conclusions: EUS-BD improves liver parameters and some aspects of life quality in patients with malignant biliary obstruction, thereby increasing their eligibility for optimal palliative care.

导言:当内镜逆行胰胆管造影术(ERCP)失败时,内镜引导胆道引流术(EUS-BD)可作为恶性胆道梗阻患者的一种抢救治疗方式。研究目的本研究探讨了 EUS-BD 对肝功能和生活质量(QoL)的影响。患者和方法:对ERCP失败的恶性胆道梗阻患者进行EUS-BD检查。使用 EQ-5D-5L 和 PSS-10 问卷评估 EUS-BD 前后的生活质量,包括瘙痒的严重程度。血清胆红素和肝功能检测分别在手术当天、两天和术后至少 14 天进行。研究结果在为期 20 个月的研究期间,共进行了 1755 例 ERCP,其中 595 例为恶性病例。其中,49 人在 ERCP 失败后接受了 EUS-BD,37 人(54% 为女性,年龄在 34-87 岁之间)完成了 14 天的随访。胰腺癌是最常见的病症(49%),住院时间中位数为 4 天。接受 EUS-BD 治疗 2 天和 14 天后,血清胆红素、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、碱性磷酸酶和γ-谷氨酰转移酶显著下降(P 均小于 0.001)。瘙痒症状明显改善,术后两周 PSS-10 量表平均降低了 5.19 分(P < 0.001)。根据 EQ-5D-5L 测量,EUS-BD 可改善焦虑和抑郁(p = 0.013)。相反,随着时间的推移,在行动能力、自理能力和日常活动方面却出现了恶化(所有 p 均小于 0.05)。11 例(30%)患者在 EUS-BD 成功后恢复了化疗。术后生存期中位数为 112 天(27-1030 天)。结论:EUS-BD 可改善恶性胆道梗阻患者的肝脏参数和某些方面的生活质量,从而提高他们接受最佳姑息治疗的资格。
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引用次数: 0
The Impact of Legalizing Medical Aid in Dying on Patient Trust: A Randomized Controlled Survey Study. 临终医疗援助合法化对患者信任的影响:随机对照调查研究
IF 2.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-01 Epub Date: 2024-08-21 DOI: 10.1089/jpm.2023.0706
Jessica B Anderson, Maria Cacciapuoti, Hannah Day, Taymour Hashemzadeh, Benjamin J Krohmal

Background: Some commentators and several professional medical associations have expressed concern that legalizing medical aid in dying ("MAID") will undermine patient trust in the medical profession, particularly among historically disadvantaged patient populations. While this concern remains influential, it has been subject to limited empirical scrutiny. Objectives: This study aims to empirically assess whether MAID legalization undermines patient trust, with considerations of potential trust/demographic correlations in marginalized and minority patient populations. Design: We developed an RCT survey study that assessed patients' trust in the medical professional using the Abbreviated Wake Forest Scale ("AWFS"). Two versions of the survey were used, each distributed at random to half of participants. One survey version included notification that MAID had been legalized in the jurisdiction where patients were receiving care and the other version omitted this information. Setting/Population: We surveyed capacitated, English-speaking adult patients who were receiving care at a not-for-profit, 912-bed academic and research hospital in Washington, D.C. Of those invited to participate, 494 patients (63.2%) completed all AWFS questions, and 70.1% identified as Black or African American and 32.9% as having a physical or mental disability. Conclusions: Most of the participants not notified that MAID was legal in DC were not aware of this fact (92.5%). Patients who were notified that MAID was legal in DC were significantly more likely to report approval of MAID legalization (p = 0.0410), but showed no significant difference in AWFS score for trust in their physicians. The study did not substantiate concerns that legalizing medical aid in dying undermines patient trust in the medical profession.

背景:一些评论家和一些专业医疗协会担心,将临终医疗援助(MAID)合法化会破坏病人对医疗行业的信任,尤其是在历史上处于弱势地位的病人群体中。尽管这种担忧仍有影响力,但对其进行的实证审查却十分有限。研究目的:本研究旨在通过实证研究评估 MAID 合法化是否会损害患者的信任,同时考虑边缘化和少数民族患者群体中潜在的信任/人口统计学相关性。设计:我们制定了一项 RCT 调查研究,使用缩写维克森林量表("AWFS")评估患者对医务人员的信任度。我们使用了两个版本的调查表,每个版本都随机分发给一半的参与者。其中一个调查版本包含患者接受治疗的司法管辖区已将 MAID 合法化的通知,而另一个版本则省略了这一信息。环境/人群:我们调查了在华盛顿特区一家拥有 912 张床位的非营利性学术研究医院接受治疗的有能力、讲英语的成年患者。在受邀参与调查的患者中,494 名患者(63.2%)完成了所有 AWFS 问题,70.1% 的患者自称是黑人或非裔美国人,32.9% 的患者自称有身体或精神残疾。结论:大多数未被告知 MAID 在华盛顿州合法的参与者并不知道这一事实(92.5%)。获得 MAID 在华盛顿州合法化通知的患者更有可能表示同意 MAID 合法化(p = 0.0410),但在对医生的信任度 AWFS 分数上没有明显差异。该研究并未证实临终关怀合法化会破坏患者对医疗行业信任的担忧。
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引用次数: 0
Top Ten Tips Palliative Care Clinicians Should Know About the Physical Manifestations of Psychiatric Illness and Treatment. 姑息关怀临床医生应了解的关于精神疾病生理表现和治疗的十大提示。
IF 2.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-01 Epub Date: 2024-05-09 DOI: 10.1089/jpm.2024.0131
Gregg A Robbins-Welty, Daniel Shalev, Paul A Riordan, Paul Noufi, Jason A Webb, Keri O Brenner, William E Rosa, Danielle Chammas

Addressing the psychiatric aspects of serious illness in palliative care (PC) is crucial to both care delivery and outcomes. Psychiatric comorbidities are common among patients with PC needs and can significantly impact their total burden of symptomatic distress, overall quality of life, functional independence, and healthcare utilization. Yet, these aspects of care are often deferred to mental health consultant teams in the context of busy PC services and often limited human resources. To provide comprehensive and person-centered care, PC clinicians must understand the interplay between medical conditions and psychiatric presentations within a biopsychosocial framework to respond empathically, efficiently, and effectively. This article is the first of a two-part series developed in collaboration with a group of psychiatric-palliative care specialists. This article explores ten common physical manifestations of psychiatric illness and treatment among patients facing serious illnesses. The second article will provide pragmatic tips PC clinicians should know about the psychiatric manifestations of nonpsychiatric serious illness and treatment. Combined, these two articles support a holistic approach that PC clinicians can use to prioritize and integrate both mental and emotional well-being throughout the continuum of serious illness.

在姑息关怀(PC)中解决重症患者的精神问题对于关怀服务的提供和结果都至关重要。在有姑息关怀需求的患者中,精神科合并症很常见,而且会对其症状困扰的总负担、整体生活质量、功能独立性和医疗保健利用率产生重大影响。然而,在 PC 服务繁忙、人力资源有限的情况下,这些方面的护理工作往往被推迟到心理健康顾问团队进行。为了提供全面的、以人为本的护理,PC 临床医生必须在生物-心理-社会框架内了解医疗条件和精神疾病表现之间的相互作用,从而以感同身受的方式做出高效、有效的反应。本文是与一组精神科姑息治疗专家合作撰写的两部分系列文章中的第一篇。本文探讨了精神疾病的十种常见生理表现,以及面临重症的患者的治疗方法。第二篇文章将提供 PC 临床医生应该了解的关于非精神科重症的精神科表现和治疗的实用技巧。综合这两篇文章,PC 临床医生可以采用一种整体方法,在重症疾病的整个过程中优先考虑并整合心理和情感健康。
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引用次数: 0
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Journal of palliative medicine
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