Differences between Pediatricians and Internists in Advance Care Planning for Adolescents with Cancer
Differences between Pediatricians and Internists in Advance Care Planning for Adolescents with Cancer
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DOI：
10.1016/j.jpeds.2016.11.079
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发表时间：
2017-03-01
影响因子：
5.1
通讯作者：
Shintaku, Haruo
中科院分区：
文献类型：
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作者：
Yotani, Nobuyuki;Kizawa, Yoshiyuki;Shintaku, Haruo
目的评价儿科医生和内科医生对青少年癌症患者实施提前护理计划（ACP）的差异及存在的障碍。研究设计：采用自我报告的问卷调查，评估儿科医生和内科医生对青少年癌症患者实施ACP、提前指导和ACP的障碍。所有3392名日本委员会认证的血液科医生接受了调查，600名血液科医生结果：当青少年癌症患者的生存预后< 3个月时，儿科医生与患者讨论ACP的可能性明显低于内科医生，包括有关患者健康状况的讨论（59% vs 70%），患者对自身病情的了解（55% vs 66%），不尝试复苏命令（17% vs 24%），如果患者病情恶化，则使用呼吸机治疗（19% vs 25%）。超过75%的血液科医生（包括儿科医生和内科医生）与患者家属讨论了所有ACP主题。同样，关于预先指示，儿科医生比内科医生更不可能与患者讨论心肺复苏（24%对47%）和使用呼吸机（31%对51%），血管加压药（24%对42%）和抗生素（21%对31%）。儿科医生和内科医生与患者家属讨论这些问题的频率高于与患者讨论这些问题的频率，尤其是心肺复苏（98%）以及呼吸机（98%）和血管加压药（91%）的使用。儿科医生和内科医生更倾向于与患者家属讨论ACP和预先指示。
Objective To evaluate differences between pediatricians and internists in the practice of and barriers to advance care planning (ACP) for adolescent patients with cancer.Study design A self-reported questionnaire was administered to assess the practice of ACP, advance directives, and barriers to ACP for adolescent patients with cancer. All 3392 Japanese board-certified hematologists were surveyed, and 600 hematologists (227 pediatricians, 373 internists) who take care of adolescent patients with cancer with decision-making capacity were analyzed.Results If a patient's prognosis for survival was < 3 months, pediatricians were significantly less likely to discuss ACP with their patients than internists, including discussions regarding the patient's medical condition (59% vs 70%), the patient's understanding of his/her medical condition (55% vs 66%), do not attempt resuscitation orders (17% vs 24%), and ventilator treatment if the patient's condition worsened (19% vs 25%). More than 75% of hematologists (both pediatricians and internists) discussed all ACP topics with patients' families. Similarly, with regard to advance directives, pediatricians were less likely than internists to discuss cardiopulmonary resuscitation (24% vs 47%) and the use of ventilators (31% vs 51%), vasopressors (24% vs 42%), and antibiotics (21% vs 31%) with their patients. Both pediatricians and internists discussed these issues more often with patients' families than with patients, especially cardiopulmonary resuscitation (98%) as well as the use of ventilators (98%) and vasopressors (91%).Conclusions Pediatricians were less likely than internists to discuss ACP and advance directives with patients, and both pediatricians and internists tended to discuss ACP and advance directives more often with patients' families.