Advance Care Planning in Patients With Cancer Referred to a Phase I Clinical Trials Program: The MD Anderson Cancer Center Experience
Advance Care Planning in Patients With Cancer Referred to a Phase I Clinical Trials Program: The MD Anderson Cancer Center Experience
复制标题
DOI：
10.1200/jco.2011.38.0758
复制
发表时间：
2012-08-10
影响因子：
45.3
通讯作者：
Kurzrock, Razelle
中科院分区：
文献类型：
--
作者：
Fu, Siqing;Barber, F. Diane;Kurzrock, Razelle
目的转诊进行早期临床试验的晚期恶性肿瘤患者的预期寿命较短。我们设计这项调查是为了确定这一人群的预先护理计划的状况。患者和方法在 I 期诊所就诊的患者被要求匿名完成一项研究者设计的调查。结果在 435 人中，215 人 (49%) 返回了完整或部分完成的调查，而许多其他人表示他们想避免这个话题，因为他们来到 I 期诊所接受癌症治疗。大多数患者（n = 149；69%）仍然对自己的未来充满希望。大约 42% 的患者 (n = 90) 报告拥有生前遗嘱，46% 的患者拥有医疗授权书 (n = 98)，19% 的患者拥有不复苏 (DNR) 命令 (n = 40)。大约 20% 的参与者 (n = 43) 没有讨论过预先护理计划。 59% 的患者希望与医生讨论预先护理计划。在拥有生前遗嘱和/或医疗授权书的个人中，获得 DNR 命令的情况明显更为常见。 结论 尽管大多数转诊至 I 期诊所的患者仍持乐观态度，但许多人已与他们的医生、家人和/或律师讨论了生前遗嘱、医疗授权书和/或 DNR 命令。然而，有相当一部分人没有向任何人讨论过这个问题，而且许多人拒绝接受有关该主题的调查。超过一半的患者希望与医生讨论这些问题。这些观察结果表明，需要付出额外的努力来解决这些患者的预先护理计划。
PurposePatients with advanced malignancies referred for early clinical trials have a short life expectancy. We designed this survey to ascertain the status of advance care planning in this population.Patients and MethodsPatients who were seen in a phase I clinic were asked to anonymously complete an investigator-designed survey.ResultsOf 435 individuals approached, 215 (49%) returned completed or partially completed surveys, whereas many others stated that they wanted to avoid the topic, because they had come to the phase I clinic for cancer therapy. Most patients (n = 149; 69%) were still hopeful about their future. Approximately 42% of patients (n = 90) reported having a living will, 46% had a medical power of attorney (n = 98), and 19% had a do-not-resuscitate (DNR) order (n = 40). Approximately 20% of participants (n = 43) had not discussed advance care planning. Fifty-nine percent of patients wanted to discuss advance care planning with their physician. Having a DNR order in place was significantly more common in individuals who had a living will and/or a medical power of attorney.ConclusionAlthough most patients referred to a phase I clinic remained optimistic, many had discussed a living will, medical power of attorney, and/or DNR order with their physician, family, and/or attorney. However, a significant minority had not addressed this issue with anyone, and many refused to take a survey on the topic. More than half of the patients wanted to discuss these matters with their physician. These observations suggest that extra effort to address advance care planning is needed for these patients.