Palliative care needs and symptom burden in younger and older patients with end-stage renal disease undergoing maintenance hemodialysis:A cross-sectional study  

维持性血液透析患者姑息照护需求和症状负担的调查研究

作　　者：Xuefei Wang Qiuyin Shi Yongzhen Mo Jing Liu Yingying Yuan 王雪菲;史秋寅;莫永珍;刘静;苑影影(School of Nursing,Department of Medicine,Soochow University,Suzhou,Jiangsu,China;Zhongda Hospital Affiliated to Southeast University,Nanjing,Jiangsu,China;Jiangsu Province Official Hospital,Nanjing,Jiangsu,China;Nanjing BenQ Medical Center,Nanjing,Jiangsu,China)

机构地区：[1]School of Nursing,Department of Medicine,Soochow University,Suzhou,Jiangsu,China [2]Zhongda Hospital Affiliated to Southeast University,Nanjing,Jiangsu,China [3]Jiangsu Province Official Hospital,Nanjing,Jiangsu,China [4]Nanjing BenQ Medical Center,Nanjing,Jiangsu,China

出　　处：《International Journal of Nursing Sciences》2022年第4期422-429,共8页国际护理科学（英文）

摘　　要：Objectives:To investigate the current situation of palliative care needs and the symptom burden in patients with end-stage renal disease(ESRD)undergoing maintenance hemodialysis(MHD),and to explore whether there are differences between younger and older patients.Methods:This cross-sectional study was conducted in the hemodialysis centers of two tertiary hospitals from November 2021 to June 2022.Participants were selected by convenience sampling.Sociodemographics,clinical characteristics,the Palliative Care Outcome Scale(POS),the Dialysis Symptom Index(DSI),and health-related quality of life(EQ-5D-3L)were used for evaluation.Descriptive statistics,between-group comparisons,and correlation analysis were used to analyze the data.Results:A total of 236 patients were enrolled,including 118 younger and 118 older patients.The total median(P25,P75)POS score was 16.0(12.0,23.0),and the score was higher in older patients(P<0.01).The mean total number of symptoms in MHD patients was 15.04±5.06,and the overall median symptom severity score was 59.0(52.0,71.0);these scores were higher in the older group(P<0.01).The most common symptom was dry mouth(91.5%),followed by itching(83.1%),and dry skin(82.2%).Additionally,palliative care needs were significantly associated with symptom burden and health-related quality of life(HRQOL).Conclusions:The results showed that patients with ESRD undergoing MHD have a significant symptom burden and moderate palliative care needs,which are more severe in older patients.Therefore,interdisciplinary teams should be formed to actively manage patients’symptoms and meet the physical,psychological,social,and spiritual needs related to palliative care to improve patients’HRQOL.目的调查行维持性血液透析的终末期肾病患者姑息照护需求和症状负担的现况,并比较老年与非老年患者姑息照护需求和症状负担的差异。方法采用横断面调查法,选取2021年11月至2022年6月南京市2所三级医院血透中心的患者作为研究对象,采用一般资料调查表、姑息照护结局量表(Palliative Care Outcome Scale,POS)、透析症状指数(Dialysis Symptom Index,DSI)、欧洲五维健康量表(The European Quality of Life 5-Dimensions 3-Levels questionnaire,EQ-5D-3L)进行资料收集。采用描述性统计方法、组间比较和相关分析等进行资料分析。结果本研究共纳入236例患者,其中非老年和老年患者各118例。结果显示维持性血液透析患者POS中位数得分为16.0(12.0,23.0),老年患者得分更高(P<0.01)。患者平均症状数目为15.04±5.06,症状严重程度的中位数得分为59.0(52.0,71.0),老年患者得分更高(P<0.01)。患者最常见的症状是口干(91.5%),其次是瘙痒(83.1%)和皮肤干燥(82.2%)。此外,姑息照护需求与症状负担和生活质量之间存在显著相关性(P<0.01)。结论行维持性血液透析的终末期肾病患者症状负担严重并有中等程度的姑息照护需求,且在老年患者中尤为明显。未来需组建跨学科的姑息照护团队,除了积极管理患者的症状外,还需满足与姑息照护相关的生理、心理、社会和精神需求,以改善患者的生活质量。

关 键 词：End-stage renal disease HEMODIALYSIS Needs assessment Palliative care Quality of life Symptom burden 

分 类 号：R473.5[医药卫生—护理学]