生命の最後の1ヶ月の癌患者の緊急治療室への出勤:体系的なレビューとメタ解析

Lesley Henson¹, Wei Gao¹, Irene Higginson¹

¹King's College London, London, UK.

Lancet (London, England)

|August 28, 2015

まとめ

男性や黒人患者や肺がん患者や低所得者層は最後の1ヶ月間緊急診療の頻度が増加しています緩和ケアではこのような訪問が少なくなり標的を絞った介入が必要とされています

科学分野:

腫瘍学
緩和ケア
医療サービス研究

背景:

終末期に迫っている癌患者の緊急治療室への訪問が増加しています
この傾向は患者の自宅でのケアを好む傾向と相反し EDの過密化を悪化させています
終末期医療の改善には診察を促す要因を理解することが重要です

研究の目的:

がん患者の生命の最後の1ヶ月におけるED出席に関連する人口統計的,臨床的,環境的要因を特定する.
対象となる介入と資源配分戦略の策定に役立つ.

主な方法:

2014年2月まで,複数のデータベース (Medline,Embase,CINAHL,PsychINFO,Cochrane Library) で広範な文献検索が行われました.
ランダム効果モデルを用いたメタアナリシスは,180万人を超える患者を対象とした30の研究で実施された.
EDの出席率に関連する要因は,確率比 (OR) として表現された.

主要な成果:

EDの出席の確率は男性 (OR1. 24),黒人 (OR1. 45),肺がん (OR1.17) と社会経済的地位の低下 (OR1.15) と関連していた.
対照的に,緩和ケアを受けた患者はEDの出席率が著しく低下した (OR0.43).

結論:

人口統計 (男性,黒人人種),臨床 (肺がん),環境 (社会経済的地位が低い,緩和ケアが不足している) の要因は,癌の末期におけるED使用の増加を予測する.
発見は,スクリーニングツールの開発を導き,よりよい資源分配のための健康政策を導くことができます.
将来の研究は,緊急治療における心理的社会的要因と患者/介護者の好みを調査すべきである.

さらに関連する動画

06:46

Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery

Published on: September 27, 2024

957

関連する概念動画

02:18

Cancer

55.1K

Cancers arise due to mutations in genes involved in the regulation of cell division, which leads to unrestricted cell proliferation. Modern science and medicine have made great strides in the understanding and treatment of cancer, including eradicating cancer in some patients. However, there is still no cure for cancer. This is largely due to the fact that cancer is a large group of many diseases.

55.1K

01:21

Cancer Survival Analysis

805

Cancer survival analysis focuses on quantifying and interpreting the time from a key starting point, such as diagnosis or the initiation of treatment, to a specific endpoint, such as remission or death. This analysis provides critical insights into treatment effectiveness and factors that influence patient outcomes, helping to shape clinical decisions and guide prognostic evaluations. A cornerstone of oncology research, survival analysis tackles the challenges of skewed, non-normally...

805

01:27

Nursing Ethical Principles II

2.3K

Ethical principles are essential in guiding nurses to fulfill their responsibilities, focusing on the quality of nursing care and decision-making. These principles, including autonomy, beneficence, non-maleficence, justice, and fidelity, shape the ethical framework within healthcare settings.
Consider the following scenario, which illustrates how these principles are applied in the care of Mr. John, a fifty-year-old teacher diagnosed with metastatic liver cancer.
Initially, Mr. John's...

2.3K

01:20

Actuarial Approach

339

The actuarial approach, a statistical method originally developed for life insurance risk assessment, is widely used to calculate survival rates in clinical and population studies. This method accounts for participants lost to follow-up or those who die from causes unrelated to the study, ensuring a more accurate representation of survival probabilities.
Consider the example of a high-risk surgical procedure with significant early-stage mortality. A two-year clinical study is conducted,...

339

01:25

Continuing Care

2.0K

Continuing care describes the variety of health, personal, and social services provided over a prolonged period. The need for continuing care is increasing because people are living longer. Many people do not have families or others to care for them. Continuing care is mainly for patients who are disabled, functionally dependent, or suffering from a terminal disease. It is available within institutional settings or in homes. Examples include nursing centers or facilities, assisted living,...