四位一体安宁疗护在老年晚期癌症患者中的应用效果

Application effect of four-in-one palliative care in elderly patients with advanced cancer

目的探讨四位一体安宁疗护(医生-护士-家属-志愿者)在老年晚期癌症患者中的应用效果,以期为临床相关领域提供参考。方法以医生-护士-家属-志愿者四位一体安宁疗护在空军军医大学第一附属医院/西京医院老年病科推行时间(2022年9月)为分界线,将推行前(2022年1—8月)的47例老年晚期癌症患者归为对照组,予以常规护理;推行后(2022年9月—2023年7月)的51例老年晚期癌症患者归为观察组,予以医生-护士-家属-志愿者四位一体安宁疗护干预。比较干预前和干预1个月时2组患者的需求情况[癌症病人需求评估量表(NEQ)]、应对方式[简易应对方式量表(SCSQ)]、心理状况[自我感受负担量表(SPBS)、心理痛苦管理筛查工具(DMSM)、患者尊严感量表(PDI)]、癌痛程度[疼痛视觉模拟量表(VAS)]和生活质量[生活质量量表(EORTC QLQ-C15-PAL)]。结果干预前,2组患者NEQ中信息需求、护理需求、亲属需求、心理支持、物质需求评分比较,差异无统计学意义(P>0.05)。干预1个月时,2组患者NEQ中信息需求、护理需求、亲属需求、心理支持、物质需求评分均高于干预前,且观察组高于对照组,差异均有统计学意义(P<0.05)。干预前,2组患者SCSQ中积极应对、消极应对评分比较,差异无统计学意义(P>0.05)。干预1个月时,2组患者SCSQ中积极应对评分均高于干预前,且观察组高于对照组,差异均有统计学意义(P<0.05);干预1个月时,2组患者SCSQ中消极应对评分均低于干预前,且观察组低于对照组,差异均有统计学意义(P<0.05)。干预前,2组患者SPBS、DMSM、PDI评分比较,差异无统计学意义(P>0.05)。干预1个月时,2组患者SPBS、DMSM、PDI评分均低于干预前,且观察组低于对照组,差异均有统计学意义(P<0.05)。干预前,2组患者VAS和EORTC QLQ-C15-PAL评分比较,差异无统计学意义(P>0.05)。干预1个月时,2组患者VAS评分均低于干预前,且观察组低于对照组,差异均有统计学意义(P<0.05);干预1个月时,2组患者EORTC QLQ-C15-PAL评分均高于干预前,且观察组高于对照组,差异均有统计学意义(P<0.05)。结论医生-护士-家属-志愿者四位一体的安宁疗护对老年晚期癌症患者具有很好的干预效果,能够更好地满足患者的需求,提高患者的生活质量,值得临床推广应用。

Objective To explore the application effect of four-in-one palliative care(physician-nurse-family-volunteer)in elderly patients with advanced cancer,with the aim of providing a reference for relevant clinical fields.Methods Taking the implementation time of four-in-one palliative care in the Department of Geriatrics of our hospital(September 2022)as the dividing line,47 elderly patients with advanced cancer before the implementation(January-August 2022)were included as the control group and received routine nursing;51 elderly patients with advanced cancer after the implementation(September 2022-July 2023)were included as the observation group and received the four-in-one(physician-nurse-family-volunteer)palliative care intervention.The needs of the two groups of patients before the intervention and one month after the intervention were compared using the Needs Evaluation Questionnaire(NEQ)in Advanced Cancer,coping methods(Short Coping Style Questionnaire,SCSQ),psychological status(Self-Perceived Burden Scale,SPBS;Distress Management Screening Measure,DMSM;Patient Dignity Inventory,PDI),cancer pain level(Visual Analogue Scale,VAS),and quality of life(European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care;EORTC QLQC15-PAL),EORTC QLQ-C15-PAL).Results Before intervention,no statistically significant difference was noted in the NEQ scores of information needs,nursing needs,family needs,psychological support,and material needs between the two groups(P>0.05).One month after the intervention,the NEQ scores of information needs,nursing needs,family needs,psychological support,and material needs in both groups were higher than before the intervention,and the observation group was higher than the control group,with statistical significance(P<0.05).Before intervention,there was no statistically significant difference in the SCSQ scores of positive coping and negative coping between the two groups(P>0.05).The SCSQ scores of positive coping in both groups were increased one month after the intervention,and the observation group was higher than the control group,with statistical significance(P<0.05);the SCSQ scores of negative coping in both groups were significantly lower than before the intervention,and the observation group was significantly lower than the control group(P<0.05).Before the intervention,no statistically significant difference was observed in the SPBS,DMSM,and PDI scores between the two groups(P>0.05).One month after the intervention,the SPBS,DMSM,and PDI scores in both groups were significantly lower than before the intervention,and the observation group was significantly lower than the control group(P<0.05).Before the intervention,no statistically significant difference was found in the VAS and EORTC QLQ-C15-PAL scores between the two groups(P>0.05).One month after the intervention,the VAS scores in both groups were significantly lower than before the intervention,and the observation group was significantly lower than the control group(P<0.05);the EORTC QLQ-C15-PAL scores in both groups were significantly higher than before the intervention,and the observation group was significantly higher than the control group(P<0.05).Conclusion The four-in-one palliative care involving physician,nurse,family,and volunteer has a good intervention effect in elderly patients with advanced cancer,can better meet the needs of patients,and raise the quality of life of patients,holding promise for a wider clinical application.