A question prompt list for patients with advanced cancer in the final year of life: Development and cross-cultural evaluation
A question prompt list for patients with advanced cancer in the final year of life: Development and cross-cultural evaluation
复制标题
晚期癌症患者生命最后一年的问题提示清单：发展与跨文化评估
DOI：
10.1177/0269216313483659
复制
发表时间：
2013
影响因子：
4.4
通讯作者：
R. Epstein
中科院分区：
文献类型：
--
作者：
A. Walczak;Benjamin L. Mazer;P. Butow;M. Tattersall;J. Clayton;P. Davidson;Jane M. Young;S. Ladwig;R. Epstein
背景：临床医生和患者发现预后和临终关怀的讨论具有挑战性。误解一个人的预后可能会导致不良的决策和生命终了时的生活质量。针对这些问题的问题提示列表（患者可以向临床医生提出的问题的小册子）可能有助于克服沟通障碍。在姑息治疗环境之外，没有关于临终关怀的讨论。目的：制定/试行问题提示列表，以促进澳大利亚和美国晚期癌症肿瘤患者的临终护理讨论/规划，并探讨使用问题提示列表的可接受性、感知获益/挑战、改进建议以及针对具体国家进行调整的必要性。设计：专家小组制定了一个问题提示列表，目标是预后和生命结束问题。澳大利亚/美国半结构化访谈和一个焦点小组引发了对问题提示列表的反馈。使用定性方法分析转录数据。背景/参与者：来自两个澳大利亚和一个美国癌症中心的34名晚期癌症患者（15名澳大利亚人/19名美国人）和13名治疗此类患者的卫生专业人员（7名澳大利亚人/6名美国人）参加了研究。结果：大多数人赞同整个问题提示列表，尽管少数人质疑某些问题的实用性/适当性。分析确定了四个全球主题：（1）加强问题提示清单的已知益处，（2）评价内容和进一步发展的建议，（3）使用问题提示清单的感知益处和挑战，（4）澳大利亚/美国反馈的对比。这些对比使得澳大利亚/美国的问题提示列表的最终版本必须截然不同。结论：与会者认为问题提示清单是可以接受和有用的。反馈产生了两个不同版本的问题提示列表，适应澳大利亚和美国的方法之间的差异，以结束生命的讨论，突出的适当性，量身定制的沟通助手，以个别人群。
Background: Clinicians and patients find prognosis and end-of-life care discussions challenging. Misunderstanding one’s prognosis can contribute to poor decision-making and end-of-life quality of life. A question prompt list (booklet of questions patients can ask clinicians) targeting these issues may help overcome communication barriers. None exists for end-of-life discussions outside the palliative care setting. Aim: To develop/pilot a question prompt list facilitating discussion/planning of end-of-life care for oncology patients with advanced cancer from Australia and the United States and to explore acceptability, perceived benefits/challenges of using the question prompt list, suggestions for improvements and the necessity of country-specific adaptations. Design: An expert panel developed a question prompt list targeting prognosis and end-of-life issues. Australian/US semi-structured interviews and one focus group elicited feedback about the question prompt list. Transcribed data were analysed using qualitative methods. Setting/participants: Thirty-four patients with advanced cancer (15 Australian/19 US) and 13 health professionals treating such patients (7 Australian/6 US) from two Australian and one US cancer centre participated. Results: Most endorsed the entire question prompt list, though a minority queried the utility/appropriateness of some questions. Analysis identified four global themes: (1) reinforcement of known benefits of question prompt lists, (2) appraisal of content and suggestions for further developments, (3) perceived benefits and challenges in using the question prompt list and (4) contrasts in Australian/US feedback. These contrasts necessitated distinct Australian/US final versions of the question prompt list. Conclusions: Participants endorsed the question prompt list as acceptable and useful. Feedback resulted in two distinct versions of the question prompt list, accommodating differences between Australian and US approaches to end-of-life discussions, highlighting the appropriateness of tailoring communication aides to individual populations.