End-of-Life Care Discussions Among Patients With Advanced Cancer A Cohort Study
End-of-Life Care Discussions Among Patients With Advanced Cancer A Cohort Study
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DOI：
10.7326/0003-4819-156-3-201202070-00008
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发表时间：
2012-02-07
影响因子：
39.2
通讯作者：
Weeks, Jane C.
中科院分区：
文献类型：
--
作者：
Mack, Jennifer W.;Cronin, Angel;Weeks, Jane C.
背景：国家指南建议医生与预期寿命不足 1 年的癌症患者讨论临终 (EOL) 护理计划。目的：评估 IV 期肺癌或结直肠癌患者进行临终关怀讨论的发生率，以及这些讨论的地点、时间和对象。设计：对 2003 年至 2005 年诊断为肺癌或结直肠癌的患者进行前瞻性队列研究。背景：参与者居住在北加利福尼亚州洛杉矶县、北卡罗来纳州、爱荷华州或阿拉巴马州，或在 5 个大型 HMO 中的 1 个或 15 个退伍军人健康管理局站点中的 1 个接受护理。患者：2155 名 IV 期肺癌或结直肠癌患者。测量：诊断后 15 个月内患者和代理人访谈中报告的临终护理讨论或病历中记录的临终护理讨论。结果：73% 的患者进行过由至少 1 个来源确定的 EOL 护理讨论。在随访期间死亡的 1470 名患者中，87% 进行了 EOL 护理讨论，而在随访结束时存活的 685 名患者中，这一比例为 41%。在记录中记录的 1081 次首次 EOL 护理讨论中，55% 发生在医院。肿瘤学家仅记录了与 27% 的患者进行的 EOL 护理讨论。在 959 名记录有 EOL 护理讨论记录且在随访期间死亡的患者中，讨论发生时间中位数为死亡前 33 天。 局限性：未评估 EOL 护理讨论的深度和质量。有关讨论的大部分信息来自在获得基线访谈之前死亡的患者的代理人。 结论：尽管大多数 IV 期肺癌或结直肠癌患者在死亡前与医生讨论 EOL 护理计划，但许多讨论发生在急性住院护理期间，与肿瘤科医生以外的提供者以及病程后期进行。
Background: National guidelines recommend that physicians discuss end-of-life (EOL) care planning with patients with cancer whose life expectancy is less than 1 year.Objective: To evaluate the incidence of EOL care discussions for patients with stage IV lung or colorectal cancer and where, when, and with whom these discussions take place.Design: Prospective cohort study of patients diagnosed with lung or colorectal cancer from 2003 to 2005.Setting: Participants lived in Northern California, Los Angeles County, North Carolina, Iowa, or Alabama or received care in 1 of 5 large HMOs or 1 of 15 Veterans Health Administration sites.Patients: 2155 patients with stage IV lung or colorectal cancer.Measurements: End-of-life care discussions reported in patient and surrogate interviews or documented in medical records through 15 months after diagnosis.Results: 73% of patients had EOL care discussions identified by at least 1 source. Among the 1470 patients who died during follow-up, 87% had EOL care discussions, compared with 41% of the 685 patients who were alive at the end of follow-up. Of the 1081 first EOL care discussions documented in records, 55% occurred in the hospital. Oncologists documented EOL care discussions with only 27% of their patients. Among 959 patients with documented EOL care discussions who died during follow-up, discussions took place a median of 33 days before death.Limitations: The depth and quality of EOL care discussions was not evaluated. Much of the information about discussions came from surrogates of patients who died before baseline interviews could be obtained.Conclusion: Although most patients with stage IV lung or colorectal cancer discuss EOL care planning with physicians before death, many discussions occur during acute hospital care, with providers other than oncologists, and late in the course of illness.