Reply to Hope, optimism, and the importance of caregivers in end-of-life care.
Reply to Hope, optimism, and the importance of caregivers in end-of-life care.
复制标题
回复希望、乐观以及护理人员在临终关怀中的重要性。
DOI：
10.1002/cncr.32441
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发表时间：
2019
期刊：
影响因子：
6.2
通讯作者：
Duberstein,PaulR
中科院分区：
文献类型：
--
作者：
Trevino,KellyM;Prigerson,HollyG;Epstein,RonaldM;Duberstein,PaulR
我们感谢Kako等人的来信，我们研究了晚期癌症患者-照顾者协议与感知预后和生命最后30天内临终关怀登记之间的关系。1总的来说，我们同意Kako等人的观点，并欢迎有机会扩大我们对这一重要主题的讨论。Kako等人提出了有关如何以及何时提供预后信息的问题，这些信息对于将研究转化为临床护理至关重要。高度结构化的公式化的预后讨论方法不太可能在与个体患者工作时有效，这些患者在疾病状态、对预后信息的情绪准备和护理人员支持等因素方面各不相同。我们的研究强调了另一个因素的重要性：护理人员对预后的理解和对患者预后理解的同意。我们认为肿瘤学家除了从患者的角度出发外，还应该从护理人员的角度来考虑预后。向护理人员提出一个简单的问题，如“您对这一信息有何看法”，可能足以确定护理人员对预后的理解差距以及患者和护理人员之间的差异。Kako等人指出，在我们的研究中，不同意预后良好的夫妇和同意预后良好的夫妇的临终关怀登记率相似。然而，事实并非如此。与我们的假设一致，对预后不一致的二联体患者比对预后良好的二联体患者有更高的安宁疗护登记率。同意预后不佳的二联体患者的临终关怀登记率最高。正如我们在研究中所述，1这一发现强调了评估护理人员预后理解的重要性，特别是当重病患者的预后相对较好时。病人往往比照护者更乐观，2但如果照护者对情况有现实的看法，他们更有可能进入安宁疗护。虽然近几十年来安宁疗护的登记人数有所增加，但对安宁疗护的使用不足（低登记率，登记接近死亡时间）已被充分记录。安宁疗护入组的预测因子为
We appreciate the letter from Kako et al regarding our examination of the relationship between advanced cancer patient–caregiver agreement regarding perceived prognosis and hospice enrollment within the last 30 days of life. 1 In general, we agree with Kako et al and welcome this opportunity to expand our discussion of this important topic.Kako et al raised questions concerning how and when prognostic information should be provided that are critical to the translation of research into clinical care. A highly structured formulaic approach to prognostic discussions is unlikely to be effective when working with individual patients who vary with regard to disease status, emotional readiness for prognostic information, and caregiver support, among other factors. Our study highlighted the importance of an additional factor: caregiver prognostic understanding and agreement with the prognostic understanding of the patient. 1 We believe that oncologists should elicit caregivers’ perspectives regarding prognosis, in addition to those of the patient. A simple question to caregivers such as,“what are your thoughts on this information” may be adequate for identifying gaps in caregiver prognostic understanding and discrepancies between patients and caregivers. Kako et al stated that rates of hospice enrollment in our study1 were similar in dyads who disagreed and dyads who agreed on a good prognosis. However, this was not the case. Consistent with our hypotheses, patients in dyads who disagreed on prognosis had significantly higher rates of hospice enrollment compared with patients in dyads who agreed on a good prognosis. Patients in dyads who agreed on a poor prognosis had the highest rates of hospice enrollment. As we stated in our study, 1 this finding highlights the importance of assessing caregiver prognostic understanding, particularly when a seriously ill patient endorses a relatively good prognosis. Patients tend to be more optimistic than caregivers, 2 but will be more likely to enter hospice if the caregiver has a realistic view of the situation. Although hospice enrollment has increased in recent decades, underuse of hospice (low enrollment rates, enrollment close to the time of death) has been well documented. 3 Predictors of hospice enrollment are