晚期肿瘤患者居家“宁养”服务的实践与思考

Practice of the Hospice Care at Home for Patients with Advanced Cancer

目的探索基于社区的晚期肿瘤患者居家"宁养"(临终关怀)服务模式,以促进晚期肿瘤患者生活质量的提高。方法在需求分析、专家咨询的基础上,建立晚期肿瘤患者居家"宁养"服务模式,在上海市杨浦区11家社区卫生服务机构进行为期2年的应用性实践,并进行定性、定量效果分析。结果 2年来共有336名晚期肿瘤患者及家庭获益,效果评估显示临终关怀服务覆盖面进一步扩大、社区卫生服务功能进一步深化、服务对象满意度提高、社会效益明显。结论本研究形成了"政府主导、专家指导、全科团队提供服务、家庭参与"的居家"宁养"服务模式,是现有资源条件下满足晚期肿瘤患者临终关怀服务需求的适宜模式,在保证服务提供者、服务经费和可操作性上具有优势,尤其适用于城市贫困家庭和农村地区。

Objective Try to find a new mode of hospice care at home for the patients with advanced cancer in community so as to improve the quality of life of the patients with advanced cancer.Methods Based on demands analysis and experts consulting,a new mode of hospice care at home for the patients with advanced cancer was established,which practiced from 2008 to 2009 in 11 community health service centers in Yangpu District,Shanghai.The performances were analyzed quantitatively and qualitatively.Results Totally 336 patients with advanced cancer received this services in 2 years.The effect analysis showed that the hospice services coverage was further expended,the function of community health services was further developed,the satisfaction of the patients was raised,and more social benefit was received.Conclusion The mode of hospice care at home for the patients with advanced cancer is established,which is ＂led by the government,guided by experts,with service provided by general practice teams and family participation＂.This service mode is appropriate to meet the demand of the patients with advanced cancer for hospice care under the existing conditions of resource,having advantages in service supply,cost,and feasibility,especially suitable for the urban poor families and rural areas.