我们能在生命的最后几天做出更准确的预测吗?
Sylvie Bouchard1,2,3,4, Andreea Paula Iancu2,5, Elena Neamt1,2,3,4
1Montreal Institute for Palliative Care, Montreal, Quebec, Canada.
Journal of palliative medicine
|March 8, 2024
概括
在生命的最后几周准确预测预期寿命至关重要. 像息性绩效量表 (PPS) 和息性预后指数 (PPI) 这样的既有工具显示出短期生存预测的前景.
科学领域:
- 抚慰性护理是一种缓解性护理.
- 预测医学是一种预测医学.
- 在生命末期的护理.
背景情况:
- 准确的预期寿命预测对于终身规划和护理至关重要.
- 现有的预后工具 (息性绩效量表 (PPS),息性预后指数 (PPI)) 已被验证为中长期预后.
- 生命的最后几周的预后需要更可靠的工具,特别是对于预后小于三周的息治疗机构的患者.
研究的目的:
- 为了提高绝症患者的短期生存预测准确度.
- 评估已建立的预后尺度和新的临床症状对短期预后的有用性.
主要方法:
- 对273名患者进行前性研究,这些患者在蒙特利尔的一家息治疗机构住院一年.
- 每天评估7个临床预后迹象即将死亡 (短期预后迹象[SPS]).
- 定期评估息性绩效表 (PPS) 和息性预后指数 (PPI) 直到患者死亡.
主要成果:
- 息性表现量 (PPS) 和息性预后指数 (PPI) 在预测存活率方面表现出很高的准确性,将它们的实用性扩展到更短的时间框架 (例如,PPS ≤20%的中位生存时间为2.5天;PPI>8的中位生存时间为3.5天).
- 任何短期预后征兆 (SPS) 的首次出现表明中位数存活时间小于一周.
- 接收器操作特征曲线证实了评估工具的高预测准确性.
结论:
- 息性表现量表 (PPS) 和息性预后指数 (PPI) 对于预测一周至三个月的存活率是有效的.
- 短期预后信号 (SPS) 在生命的最后一周提供了有价值的预后信息.
- 将SPS与PPS和PPI整合起来,可以显著提高在各种终身诊断中短期生存预测的准确性,帮助治疗适应,护理设置决策和患者与家庭沟通.
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