探视限制对姑息治疗患者疼痛和心理健康的影响:一项队列研究

Yiran Tu, Mark Tacey, Jaclyn Yoong
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摘要

目的:在 COVID-19 大流行期间,住院的晚期或危及生命的姑息治疗患者可能会受到探视限制(VR)的影响。我们旨在探讨访客限制对患者身体疼痛和心理困扰程度的影响。设计:回顾性队列研究,比较澳大利亚一家大型都市医院姑息治疗病房收治的两组患者;第一组从 2019 年 4 月 1 日至 6 月 30 日(大流行前;n = 96),第二组从 2020 年 4 月 1 日至 6 月 30 日(大流行期间;n = 95)。研究方法比较大流行前和大流行期间的患者入院、出院或死亡时的患者疼痛评分(使用症状评估量表 SAS)和临床医生疼痛评分以及心理/精神严重程度评分(使用姑息治疗问题严重程度评分 PCPSS)。还通过多变量分析评估了出院疼痛评分以及从入院到出院的评分变化。研究结果两组患者的病例组合相似。在对人口统计学和功能状态进行调整后,与大流行前队列相比,大流行队列中出院时死亡患者的疼痛评分更高(SAS:系数=0.86,95%CI:0.09 至 1.64,P=0.029;PCPSS:系数=0.24,95%CI:-0.07 至 0.86,P=0.131)。生还出院者的 SAS 和 PCPSS 疼痛和心理/精神评分差异无统计学意义。结论在受虚拟现实影响的姑息治疗住院患者中,我们观察到死亡出院患者的疼痛评分较高;这表明虚拟现实可能影响了这些患者的身体健康(疼痛)。
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Impact of Visitor Restrictions on the Pain and Psychological Wellbeing of Palliative Care Patients: A Cohort Study.

Aim: Palliative care patients with advanced or life-threatening illnesses in hospital during the COVID-19 pandemic are likely to be affected by visitor restrictions (VR). We aimed to explore the impact of VR on patients' levels of physical pain and psychological distress. Design: Retrospective cohort study comparing two cohorts of patients admitted to a palliative care unit in a major metropolitan hospital in Australia; the first cohort from 1 April to 30 June 2019 (pre-pandemic; n = 96), and the second from 1 April to 30 June 2020 (during pandemic; n = 95). Methods: Patient-rated pain scores (using the Symptom Assessment Scale; SAS) and clinician-rated pain and psychological/spiritual severity scores (using the Palliative Care Problem Severity Score; PCPSS) on admission and on discharge or death were compared between pre-pandemic and pandemic cohorts. Discharge pain scores and change in scores from admission to discharge were also assessed via multivariable analyses. Results: Case-mix of patients in both cohorts were similar. After adjusting for demographics and functional status, pain scores in the pandemic cohort were higher for patients deceased on discharge, compared to the pre-pandemic cohort (SAS: coefficient = 0.86, 95%CI: 0.09 to 1.64, P = 0.029; PCPSS: coefficient = 0.24, 95%CI: -0.07 to 0.86, P = 0.131, respectively). Differences in SAS and PCPSS pain and psychological/spiritual scores for those discharged alive were not statistically significant. Conclusion: Among palliative care inpatients affected by VR, we observed higher pain scores for patients discharged deceased; suggesting that VR may have impacted the physical wellbeing (pain) of these patients.

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