在外科瘤诊所内的早期综合息治疗
Varun V Bansal1, Daniel Kim2, Biren Reddy3
1Division of Surgical Oncology, Yale School of Medicine, New Haven, Connecticut.
JAMA network open
|November 7, 2023
概括
将预先的护理计划纳入外科手术工作流程,增加了晚期癌症患者的预先指令指定的比例. 这凸显了早期息护理整合对于改善以患者为中心的护理和目标对齐的重要性.
科学领域:
- 在瘤学瘤学.
- 抚慰性护理是一种缓解性护理.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 预先指示 (ADs) 对于将患者护理与目标保持一致至关重要,但在高风险的外科癌症患者中未得到充分利用.
- 在这个弱势群体中,AD指定障碍很普遍,需要有针对性的干预措施.
研究的目的:
- 评估早期息护理整合对接受手术的癌症患者的AD指定率的影响.
- 评估干预后AD文档的变化.
主要方法:
- 一项回顾性队列研究分析了接受选择性手术的高级腹部和软组织恶性瘤的成年患者的数据.
- 2020年实施了一项综合预先护理计划 (ACP) 倡议,包括早期息护理咨询.
- 多变量后勤回归确定了与AD指定和文档相关的因素.
主要成果:
- 总体AD指标率为77.9%,从干预前的72.0%显著增加到干预后的85.4% (P=.004).
- 阿尔茨海默病的指定与息护理咨询,息意图治疗,年龄较大和综合工作流相关.
- 来自少数种族/少数民族的患者不太可能指定ADs (OR,0.36;P=.008).
- 干预后的AD记录率并没有显著增加.
结论:
- 将ACP和早期息护理整合到外科手术工作流程中是可行的,并且与晚期癌症手术患者的AD指定率增加有关.
- 这些发现强调了修改临床途径和利用电子健康记录干预措施的价值,以加强以患者为中心的护理.
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