Beliefs About Advanced Cancer Curability in Older Patients, Their Caregivers, and Oncologists
Beliefs About Advanced Cancer Curability in Older Patients, Their Caregivers, and Oncologists
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DOI：
10.1634/theoncologist.2018-0890
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发表时间：
2019-06-01
期刊：
影响因子：
5.8
通讯作者：
Duberstein, Paul
中科院分区：
文献类型：
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作者：
Loh, Kah Poh;Mohile, Supriya G.;Duberstein, Paul
背景 确保患有晚期癌症的老年患者和他们的肿瘤科医生对治愈性有相似的信念非常重要。我们调查了患者-肿瘤科医生和护理人员-肿瘤科医生二人对治愈性信念的不一致。材料和方法我们使用了一项整群随机试验的基线数据，该试验评估老年评估是否可以改善老年晚期癌症患者及其护理人员的沟通和生活质量。患者年龄 >= 70 岁，患有社区肿瘤学实践中无法治愈的癌症。患者、护理人员和肿瘤科医生被问到：“您认为癌症消失并且通过治疗不再复发的可能性有多大？”选项为 100%、>50%、50/50、= 3 分（严重）。我们使用多元逻辑回归来描述不一致的相关性。结果 336 名患者-肿瘤科医生二人组中 60%（15% 严重）存在不一致，245 名护理人员-肿瘤科医生二人组中 52%（16% 严重）存在不一致。当肿瘤科医生执业时间较长（调整后比值比 [AOR] 0.90，95% 置信区间 [CI] 0.84-0.97）时，患者与肿瘤科医生二人组中不一致的情况较少见，而在非西班牙裔白人患者（AOR 5.77，CI 1.90-17.50）和患者患有肺部疾病（AOR 1.95，CI）时，不一致更为常见。 1.29-2.94）或胃肠道癌（AOR 1.55，CI 1.09-2.21）与乳腺癌相比。当患者是非西班牙裔白人、收入较低且社会支持受损时，严重不一致更为常见。当护理人员是非西班牙裔白人（AOR 3.32，CI 1.01-10.94）并且报告身体健康状况较低（AOR 0.88，CI 0.78-1.00）时，护理人员与肿瘤科医生的不一致更为常见。当护理人员收入较低且焦虑水平较低时，严重的不一致更为常见。结论 对可治愈性的信念不一致很常见，有时甚至很严重，并且与患者、护理人员和肿瘤科医生的特征相关。对实践的意义 确保患有晚期癌症的老年患者及其护理人员对治愈性有相似的信念，这一点与肿瘤科医生一样重要。这项研究调查了患者-肿瘤科医生（PO）和护理人员-肿瘤科医生（CO）二人对治愈性信念的不一致。结果发现，60%（15%严重）的 PO 二元组和 52%（16%严重）的 CO 二元组存在不一致，这对患者同意治疗的过程提出了严重质疑。这项研究支持针对肿瘤学家、患者、护理人员和社会层面进行干预的必要性，以改善预后信息的传递以及患者/护理人员对预后的理解和接受。
Background Ensuring older patients with advanced cancer and their oncologists have similar beliefs about curability is important. We investigated discordance in beliefs about curability in patient-oncologist and caregiver-oncologist dyads. Materials and Methods We used baseline data from a cluster randomized trial assessing whether geriatric assessment improves communication and quality of life in older patients with advanced cancer and their caregivers. Patients were aged >= 70 years with incurable cancer from community oncology practices. Patients, caregivers, and oncologists were asked: "What do you believe are the chances the cancer will go away and never come back with treatment?" Options were 100%, >50%, 50/50, = 3 points were severe). We used multivariate logistic regressions to describe correlates of discordance. Results Discordance was present in 60% (15% severe) of the 336 patient-oncologist dyads and 52% (16% severe) of the 245 caregiver-oncologist dyads. Discordance was less common in patient-oncologist dyads when oncologists practiced longer (adjusted odds ratio [AOR] 0.90, 95% confidence interval [CI] 0.84-0.97) and more common in non-Hispanic white patients (AOR 5.77, CI 1.90-17.50) and when patients had lung (AOR 1.95, CI 1.29-2.94) or gastrointestinal (AOR 1.55, CI 1.09-2.21) compared with breast cancer. Severe discordance was more common when patients were non-Hispanic white, had lower income, and had impaired social support. Caregiver-oncologist discordance was more common when caregivers were non-Hispanic white (AOR 3.32, CI 1.01-10.94) and reported lower physical health (AOR 0.88, CI 0.78-1.00). Severe discordance was more common when caregivers had lower income and lower anxiety level. Conclusion Discordance in beliefs about curability is common, occasionally severe, and correlated with patient, caregiver, and oncologist characteristics. Implications for Practice Ensuring older patients with advanced cancer and their caregivers have similar beliefs about curability as the oncologist is important. This study investigated discordance in beliefs about curability in patient-oncologist (PO) and caregiver-oncologist (CO) dyads. It found that discordance was present in 60% (15% severe) of PO dyads and 52% (16% severe) of CO dyads, raising serious questions about the process by which patients consent to treatment. This study supports the need for interventions targeted at the oncologist, patient, caregiver, and societal levels to improve the delivery of prognostic information and patients'/caregivers' understanding and acceptance of prognosis.