Association between the amount of artificial hydration and quality of dying among terminally ill patients with cancer: The East Asian Collaborative Cross-Cultural Study to Elucidate the Dying Process
Association between the amount of artificial hydration and quality of dying among terminally ill patients with cancer: The East Asian Collaborative Cross-Cultural Study to Elucidate the Dying Process
复制标题
DOI：
10.1002/cncr.34108
复制
发表时间：
2022-02-01
期刊：
影响因子：
6.2
通讯作者：
Mori, Masanori
中科院分区：
文献类型：
--
作者：
Wu, Chien-Yi;Chen, Ping-Jen;Mori, Masanori
研究背景：人工水化（AH）是晚期癌症患者面临的一个挑战性问题，因为它影响患者的症状控制、生活质量和死亡质量（QOD）。到目前为止，尚不清楚有多少AH供应适合于即将死亡的患者。本研究旨在探讨AH的量与QOD之间的关系。方法本研究是2017年1月至2018年9月在日本，韩国和台湾进行的东亚合作跨文化研究（EASED）的一部分。记录患者的人口统计学资料、症状和进入姑息治疗病房（PCU）时和死亡前的管理情况。以250-mL为间隔将AH量分为不同组以比较它们的差异。使用良好死亡量表（GDS）测量QOD，使用GDS = 12作为截止点将患者分为较高或较低QOD组。我们使用逻辑回归分析来评估AH量与QOD之间的关联。结果共纳入1530例患者。国家、宗教、精神健康、疲劳、谵妄、呼吸困难、AH和死亡前使用抗生素与QOD显著相关。进行回归分析后，接受250 - 499 mL AH的患者的QOD显著优于未接受AH的患者（比值比，2.251; 95%置信区间，1.072-4.730; P = .032）。结论AH的使用影响了PCUs收治的晚期癌症患者的QOD。与患者及其家属就AH的适当使用进行沟通对QOD有积极影响。我们的前瞻性跨文化多中心研究旨在调查晚期癌症患者中人工水化（AH）量与死亡质量之间的关系。研究结果显示，国家、宗教、精神健康、疲劳、谵妄、呼吸困难、AH和死亡前使用抗生素与死亡质量（QOD）显著相关。多变量logistic回归分析后，AH剂量为250 - 499 mL的患者QOD显著优于未使用AH的患者（比值比，2.251; 95%置信区间，1.072-4.730; P = .032）。建议与患者及其家属就AH进行沟通，因为这可能有助于他们为生命终了阶段做好更好的准备，并实现良好的死亡。
Background Artificial hydration (AH) is a challenging issue in terminally ill patients with cancer, because it influences patients' symptoms control, quality of life, and quality of dying (QOD). To date, it is not clear how much AH supply is proper for imminently dying patients. This study aimed to investigate the association between the amount of AH and QOD. Methods This study is part of the East Asian Collaborative Cross-Cultural Study to Elucidate the Dying Process (EASED) conducted in Japan, Korea, and Taiwan from January 2017 to September 2018. Patients' demographics, symptoms, and managements on admission to palliative care units (PCUs) and before death were recorded. The AH amount was classified into different groups by 250-mL intervals to compare their difference. The Good Death Scale (GDS) was used to measure QOD, with patients classified into higher or lower QOD groups using GDS = 12 as the cutoff point. We used logistic regression analysis to assess the association between AH amount and QOD. Results In total, 1530 patients were included in the analysis. Country, religion, spiritual well-being, fatigue, delirium, dyspnea, AH, and antibiotics use before death were significantly associated with QOD. After conducting regression analysis, patients administered with 250 to 499 mL AH had significantly better QOD (odds ratio, 2.251; 95% confidence interval, 1.072-4.730; P = .032) than those without AH. Conclusions AH use impacts the QOD of terminally ill patients with cancer admitted to PCUs. Communication with patients and their families on appropriate AH use has a positive effect on QOD. Lay Summary Our prospective cross-cultural multicenter study aims to investigate the relationship between artificial hydration (AH) amount and quality of dying among terminally ill patients with cancer. The findings reveal that country, religion, spiritual well-being, fatigue, delirium, dyspnea, AH, and antibiotics use before death were significantly associated with quality of death (QOD). After multivariable logistic regression, patients administered with AH amount 250 to 499 mL had significantly better QOD (odds ratio, 2.251; 95% confidence interval, 1.072-4.730; P = .032) than those without AH. Communication with patients and their families regarding AH is recommended as it may help them be better prepared for the end-of-life stage and achieve a good death.