Preferred and Actual Involvement of Advanced Lung Cancer Patients and Their Families in End-of-Life Decision Making: A Multicenter Study in 13 Hospitals in Flanders, Belgium
Preferred and Actual Involvement of Advanced Lung Cancer Patients and Their Families in End-of-Life Decision Making: A Multicenter Study in 13 Hospitals in Flanders, Belgium
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DOI：
10.1016/j.jpainsymman.2011.04.008
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发表时间：
2012-03-01
影响因子：
4.7
通讯作者：
Deliens, Luc
中科院分区：
文献类型：
--
作者：
Pardon, Koen;Deschepper, Reginald;Deliens, Luc
上下文死亡之前通常会做出可能缩短生命的医疗决定（生命终结决定[ELD]），例如，停止或停止治疗的决定。尊重患者自主权要求医生让患者参与决策。本研究的目的是检查晚期肺癌患者及其家属参与ELD制作，并比较他们的实际参与与他们以前所说的参与偏好。IIIb/IV期非小细胞肺癌患者由13家医院的医生招募，并在诊断和死亡之间定期进行访谈。当病人死亡时，专家和全科医生被要求填写一份遗嘱。85例在诊断后18个月内死亡的患者进行了研究。52例（61%）进行了ELD。根据主治医生的说法，一半有能力的患者没有参与ELD的决策，四分之一的患者与医生分享决策，四分之一的患者自己做出决策。在无行为能力的患者中，家庭参与的占一半。有能力的患者中有一半的参与程度低于他们之前的偏好，7%的参与程度更高。几乎所有的不称职的病人以前曾表示，他们希望他们的家人参与的情况下，不称职，但一半没有实现这一点。在一半的病例中，晚期肺癌患者或他们的家庭在无能的情况下没有参与ELD制作，尽管他们中的大多数人都希望这样做。医生应与晚期肺癌患者公开讨论ELD和参与偏好。J Pain Symptom Manage 2012;43：515-526. (C)2012年美国S.癌症疼痛缓解委员会。爱思唯尔公司出版All rights reserved.
Context. Death is often preceded by medical decisions that potentially shorten life (end-of-life decisions [ELDs]), for example, the decision to withhold or withdraw treatment. Respect for patient autonomy requires physicians to involve their patients in this decision making.Objectives. The objective of this study was to examine the involvement of advanced lung cancer patients and their families in ELD making and compare their actual involvement with their previously stated preferences for involvement.Methods. Patients with Stage IIIb/IV non-small cell lung cancer were recruited by physicians in 13 hospitals and regularly interviewed between diagnosis and death. When the patient died, the specialist and general practitioner were asked to fill in a questionnaire.Results. Eighty-five patients who died within 18 months of diagnosis were studied. An ELD was made in 52 cases (61%). According to the treating physician, half of the competent patients were not involved in the ELD making, one-quarter shared the decision with the physician, and one-quarter made the decision themselves. In the incompetent patients, family was involved in half of cases. Half of the competent patients were involved less than they had previously preferred, and 7% were more involved. Almost all of the incompetent patients had previously stated that they wanted their family involved in case of incompetence, but half did not achieve this.Conclusion. In half of the cases, advanced lung cancer patients-or their families in cases of incompetence-were not involved in ELD making, despite the wishes of most of them. Physicians should openly discuss ELDs and involvement preferences with their advanced lung cancer patients. J Pain Symptom Manage 2012;43:515-526. (C) 2012 U. S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.