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Improvement of Pain Control in Palliative/Hospice Home Care: Experience of a Single Institution

關鍵字   pain control;cancer pain;terminal care;palliative care;hospice;home care;疼痛控制;癌症疼痛;末期照顧;緩和照顧;安寧緩和;居家照顧  

 作者  劉惠文(Hui-Wen Liu);陳苓萍(Ling-Ping Chen);宋詠娟(Yung-Chuan Sung)

並列摘要


背景:文獻回顧台灣的癌症門診病患於疾病惡化時疼痛分數為3.62至4.47分,末期病患約有三分之二有中度以上疼痛,疼痛照顧尤需重視。由單一醫學中心的收案分析,了解密集居家與電話訪視的安寧居家照護模式可改善病人的疼痛控制程度。病人與方法:回溯性分析國泰綜合醫院接受安寧居家照護之病人,自2011年1月至2013年10月收案兩週以上且接受疼痛藥物控制病人共79人,其中部份因病人死亡病歷封存於外地不可得,有居家照護書面疼痛控制評估資料者共的人,排除無法使用疼痛視覺類比量表(VAS)後,能參與分析者共33人。根據病歷回顧,VAS以收案起兩週為間距進行疼痛評估分析,最長分析至收案後十週。統計方式使用paired t-test 。結果:接受分析的案例33人中,女性佔20人( 60.6% ),男性佔13人(39.4%),平均年齡為68.82歲,中位數為69歲,平均收案天數為118天, 中位數為92天(標準差93.1) 。收案時33人VAS 平均為4.82,中位數為5分,中度疼痛比例為57.6%,嚴重疼痛為18.2%,與收案時VAS比較收案後兩週時VAS (29人) 平均為4.79 vs. 2.28分(p<0.001) ,輕度疼痛病人佔58.6%,另有20.7%不感到疼痛;安寧居家照護收案後兩週至八週皆顯著改善視覺類比量表(VAS)的分數(p<0.001),於末期病人照顧過程中,至第四至十週追蹤之病人仍有六成以上的輕度疼痛控制效果。結論:接受安寧緩和居家照護的病人的確可以改善其疼痛控制,第二週在含輕度疼痛以下可達79.3%,至第八週都能顯著改善VAS分數(p<0.001)。

摘要 Summary


Background: Review the pain score of Taiwan cancer outpatients when disease deterioration, the average score is 3.62 to 4.47 (0-10). Terminal cancer pain care is more important due to two-thirds patients with more than moderate level pain. From a single institution analysis, we knew the improvement of pain control in palliative home care mode with home visits and telephone visits. Patients and Methods: From January 2011 to October 2013, we retrospectively analyzed hospice home care patients, excluded less than 2 weeks, no available medical records, and patients could not use VAS table due to cognition. Total 33 patients were included in study finally. We analyzed VAS every 2 weeks till 10 weeks according to medical records. Statistics methods use paired t-test. Results: In 33 home care patients, there were 20 females (60.6%) and 13 males (39.4%). The average patient age was 68.82 year-old, median was 69 year-old. The average duration receiving home care was 118 days; median was 92 days (SD 93.1 days). The baseline VAS of 33 patients was 4.82, median was 5, the moderate pain (VAS between 4 and 6) was 57.6% and severe pain (VAS more than 6) was 18.2%. The average VAS at 2 weeks was 2.28 compared to baseline 4.79 (N=29, p<0.001), and 58.6% patients felt mild pain even 20.7% felt no pain. During hospice home care, the VAS improved statistically at 2 weeks till 8 weeks. The pain level less than moderate status achieved 79.3% at 2 weeks and more than 60% even to 4-10 weeks. Conclusions: Patients received palliative/hospice home cares indeed improve pain control. The pain control with mild pain and no pain was 79.3% when 2 weeks, and VAS improved statistically till 8 weeks (p<0.001).

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