上海市四平社区晚期癌症患者居家临终关怀服务回顾性研究

上海市四平社区晚期癌症患者居家临终关怀服务回顾性研

究

摘要目的：总结2008-2013年社区开展晚期癌症患者居家临终关怀现状和现有服务模式。方法：收集2008年1月至2013年12月31日接受居家临终关怀服务的癌症患者180例，卡氏评分（62±9）分，按管理方式不同分为三组。组1（38例）为服药管理组，组2（33例）为上门关怀组，组3（109例）为电话关怀组。回顾分析居家临终关怀现状和现有服务模式。结果：180例患者的平均临终关怀服务时间108 d，三组患者治疗意愿间差异有统计学意义（χ

2=14.753，P<0.05）。采用“镇痛评估治疗、对症处理、家庭指导、心理支持关怀”为服务核心内容，累计服务1 176人次，初步形成“社区筛查评估、全科医生分级管理、家庭参与”的居家临终关怀服务模式。结论：居家临终关怀是满足晚期肿瘤患者需求的适宜模式，但仍面临服务内容完善和适宜技术规范化等问题，需加大宣传和扩大覆盖面。

关键词临终关怀居家晚期癌症回顾研究

中图分类号：R48/R73 文献标识码：A 文章编号：1006-1533（2015）06-0047-04

ABSTRACT Objective：To know the present situation of

the hospice care at home for the patients with the advanced cancer developed in the community from 2008 to 2013 and summarize the present service model. Methods：One hundred and eighty cases with the cancer who received the hospice care at home from January 2008 to December 2013 were selected，their Karnofsky score was 62±9，and were divided into three groups according to the management models. The group 1 with 38 cases was as the medication management group，the group 2 with 33 cases as the home care one and the group 3 as the telephone care one. The situation of the hospice care at home and present service model were analyzed retrospectively. Results：The average time of the hospice care service of 180 cases was 108 days and the difference in the treatment willingness of the patients in the three groups had the statistical significance （χ2=14.753，P<0.05）. The contents of the service care included the pain assessment and treatment，symptomatic treatment，family guidance and psychological support and care. The cumulative service was 1 176 person times. The model of the hospice care at home was initially formed，which covered the community screening assessment，hierarchical management of GP and family participation. Conclusion：The hospice care at home is an appropriate model

to meet the demand of the patients with the advanced cancer. But，it faces some problems of the improvement of the contents of the hospice service at home and standardization of the appropriate technology and needs to increase the propaganda and expand the coverage.

KEY WORDS hospice care；home；advanced cancer；retrospective analysis

临终关怀服务对象包括所有晚期临终阶段及濒死状态

的患者，晚期癌症患者是目前临终关怀的重要对象之一[1] 。2008年上海市杨浦区卫生计划生育委员会在所有社区卫生服务中心开展了针对本社区晚期癌症患者免费居家宁

养舒缓服务，旨在缓解晚期癌症患者生理和心理的痛苦，提高生活质量。本文通过回顾性总结杨浦区四平社区卫生服务中心开展的社区居家临终关怀服务现状和现有服务模式，为进一步完善居家临终关怀服务提供参考。

材料与方法

一般资料

收集2008年1月至2013年12月31日社区居家宁养舒缓服务统计报表中的癌症患者180例，其中男性101例（56.11%），女性79例（43.89%），年龄26～98岁，平均（71±12）岁，60岁及以上老年人138例，占76.67%，80岁及以上老年人41例，占22.78%，卡氏（Karnofsky，KPS）评