Factors important to patients' quality of life at the end of life.
Factors important to patients' quality of life at the end of life.
复制标题
DOI：
10.1001/archinternmed.2012.2364
复制
发表时间：
2012-08-13
影响因子：
--
通讯作者：
Prigerson, Holly G.
中科院分区：
文献类型：
--
作者：
Zhang, Baohui;Nilsson, Matthew E.;Prigerson, Holly G.
当治愈性治疗不再是垂死癌症患者的选择时，护理的重点往往从延长生命转向提高生活质量（QOL）。关于晚期癌症患者在生命末期（EOL）预测更好的QOL的数据有限。确定在EOL时最影响QOL的因素，从而确定有希望的干预目标，以促进EOL QOL。应对癌症（CwC 1）是一项美国多中心、前瞻性、纵向队列研究，研究对象为2002年9月至2008年2月期间入组的晚期癌症患者（n=396例患者）及其非正式护理人员。患者从入组到死亡的平均随访时间为4.1个月。生命最后一周的患者QOL是CwC 1和本报告的主要结局。以下一组9个因素，前面有一个指示效应方向的符号，并按重要性排序，解释了患者EOL QOL的最大差异：#1=（−）ICU停留在最后一周（解释EOL QOL方差的4.40%），#2 =（−）住院死亡（2.70%），#3 =（−）基线时患者担忧（2.70%），#4 =（+）基线时宗教祈祷或冥想（2.50%），#5 =癌症治疗部位（1.80%），#6 =（−）最后一周使用饲管（1.10%），#7 =（+）医院/诊所内的牧师护理（1.10%），#8 =（-）最后一周的化疗（0.90%），#9 =（+）患者-医生治疗联盟（0.70%）。然而，EOL QOL的大部分差异仍然无法解释（82.3%）。晚期癌症患者避免住院和重症监护，不担心，祈祷或冥想，在医院/诊所由牧师访问，并且感觉与医生的治疗联盟在EOL时具有最高的QOL。
When curative treatments are no longer options for dying cancer patients, the focus of care often turns from prolonging life to promoting quality-of-life (QOL). Limited data exist on what predicts better QOL at the end-of-life (EOL) for advanced cancer patients. To determine the factors that most influence QOL at the EOL, thereby, identifying promising targets for interventions to promote EOL QOL. Coping with Cancer (CwC1) is a US multi-site, prospective, longitudinal cohort study of advanced cancer patients (n=396 patients) and their informal caregivers, who were enrolled between September 2002 and February 2008. Patients were followed from enrollment to death a median of 4.1 months later. Patient QOL in the last week of life was the primary outcome of both CwC1 and the present report. The following set of 9 factors, preceded by a sign indicating the direction of the effect and presented in rank-order of importance, explained the most variance in patients’ EOL QOL: #1=(−) ICU stays in the final week (explained 4.40% of the variance in EOL QOL), #2 = (−) hospital deaths (2.70%), #3 =(−) patient worry at baseline (2.70%), #4 = (+) religious prayer or meditation at baseline (2.50%), #5 = site of cancer care (1.80%), #6 = (−) feeding-tube use in the final week (1.10%), #7 = (+) pastoral care within the hospital/clinic (1.10%), #8 = (−) chemotherapy in the final week (0.90%), and #9 = (+) patient-physician therapeutic alliance (0.70%) at baseline. Most of the variance in EOL QOL, however, remained unexplained (82.3%). Advanced cancer patients who avoid hospitalizations and intensive care, who are not worried, who pray or meditate, who are visited by a pastor in the hospital/clinic, and who feel a therapeutic alliance with their physicians have the highest QOL at the EOL.
登录
查看更多内容
影响因子：
120.7
作者：
Phelps, Andrea C.;Maciejewski, Paul K.;Prigerson, Holly G.
通讯作者：
Prigerson, Holly G.
影响因子：
7.6
作者：
CARVER, CS;SCHEIER, MF;WEINTRAUB, JK
通讯作者：
WEINTRAUB, JK
影响因子：
3.8
作者：
Lichtenthal, Wendy G.;Nilsson, Matthew;Prigerson, Holly G.
通讯作者：
Prigerson, Holly G.
DOI：
10.7326/0003-4819-139-5_part_2-200309021-00006
发表时间：
2003-09-02
影响因子：
39.2
作者：
Patrick, DL;Curtis, JR;McCown, E
通讯作者：
McCown, E
影响因子：
--
作者：
Hales, Sarah;Zimmermann, Camilla;Rodin, Gary
通讯作者：
Rodin, Gary