美国癌症中心姑息治疗的可及性和整合。
Availability and integration of palliative care at US cancer centers.
机构信息
Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
出版信息
JAMA. 2010 Mar 17;303(11):1054-61. doi: 10.1001/jama.2010.258.
CONTEXT
The current state of palliative care in cancer centers is not known.
OBJECTIVES
To determine the availability and degree of integration of palliative care services and to compare between National Cancer Institute (NCI) and non-NCI cancer centers in the United States.
DESIGN, SETTING, AND PARTICIPANTS: A survey of 71 NCI-designated cancer centers and a random sample of 71 non-NCI cancer centers of both executives and palliative care clinical program leaders, where applicable, regarding their palliative care services between June and October 2009. Survey questions were generated after a comprehensive literature search, review of guidelines from the National Quality Forum, and discussions among 7 physicians with research interest in palliative oncology. Executives were also asked about their attitudes toward palliative care.
MAIN OUTCOME MEASURE
Availability of palliative care services in the cancer center, defined as the presence of at least 1 palliative care physician.
RESULTS
A total of 142 and 120 surveys were sent to executives and program leaders, with response rates of 71% and 82%, respectively. National Cancer Institute cancer centers were significantly more likely to have a palliative care program (50/51 [98%] vs 39/50 [78%]; P = .002), at least 1 palliative care physician (46/50 [92%] vs 28/38 [74%]; P = .04), an inpatient palliative care consultation team (47/51 [92%] vs 28/50 [56%]; P < .001), and an outpatient palliative care clinic (30/51 [59%] vs 11/50 [22%]; P < .001). Few centers had dedicated palliative care beds (23/101 [23%]) or an institution-operated hospice (37/101 [37%]). The median (interquartile range) reported durations from referral to death were 7 (4-16), 7 (5-10), and 90 (30-120) days for inpatient consultation teams, inpatient units, and outpatient clinics, respectively. Research programs, palliative care fellowships, and mandatory rotations for oncology fellows were uncommon. Executives were supportive of stronger integration and increasing palliative care resources.
CONCLUSION
Most cancer centers reported a palliative care program, although the scope of services and the degree of integration varied widely.
背景
目前尚不清楚癌症中心的姑息治疗现状。
目的
确定姑息治疗服务的提供情况和整合程度，并比较美国国立癌症研究所（NCI）指定癌症中心与非 NCI 癌症中心之间的差异。
设计、地点和参与者：2009 年 6 月至 10 月期间，对 71 家 NCI 指定癌症中心和 71 家非 NCI 癌症中心的管理人员以及姑息治疗临床项目负责人（如适用）进行了一项调查，调查内容涉及他们的姑息治疗服务。调查问题是在对综合文献检索、国家质量论坛指南进行审查以及与 7 名对姑息肿瘤学研究感兴趣的医生进行讨论后生成的。管理人员还被问及他们对姑息治疗的态度。
主要观察指标
癌症中心姑息治疗服务的提供情况，定义为至少有 1 名姑息治疗医生。
结果
共向管理人员和项目负责人发送了 142 份和 120 份调查问卷，回复率分别为 71%和 82%。NCI 癌症中心更有可能设立姑息治疗项目（50/51 [98%]比 39/50 [78%]；P=.002）、至少有 1 名姑息治疗医生（46/50 [92%]比 28/38 [74%]；P=.04）、住院姑息治疗咨询团队（47/51 [92%]比 28/50 [56%]；P <.001）和门诊姑息治疗诊所（30/51 [59%]比 11/50 [22%]；P <.001）。很少有中心有专门的姑息治疗床位（23/101 [23%]）或机构运营的临终关怀病房（37/101 [37%]）。从转介到死亡的中位（四分位间距）时间分别为住院咨询团队的 7（4-16）天、住院病房的 7（5-10）天和门诊诊所的 90（30-120）天。姑息治疗研究员项目、奖学金和肿瘤学研究员必修轮训并不常见。管理人员支持加强整合并增加姑息治疗资源。
结论
大多数癌症中心报告称设立了姑息治疗项目，但服务范围和整合程度差异很大。
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