Hope and advance care planning in advanced cancer: Is there a relationship?
Hope and advance care planning in advanced cancer: Is there a relationship?
复制标题
晚期癌症的希望和预先护理计划：有关系吗？
DOI：
10.1002/cncr.34034
复制
发表时间：
2022-03-15
期刊：
影响因子：
6.2
通讯作者：
Schenker Y
中科院分区：
文献类型：
--
作者：
Cohen MG;Althouse AD;Arnold RM;Bulls HW;White DB;Chu E;Rosenzweig MQ;Smith KJ;Schenker Y
临床医生经常把害怕“放弃希望”作为推迟对晚期癌症患者进行预先护理计划（ACP）的原因。我们试图确定参与ACP是否会影响患者的希望。这是一项晚期癌症初级姑息治疗的随机对照试验的二次分析。基线时未完成ACP的患者也被纳入分析。ACP的评估形式包括与肿瘤学家的临终谈话（EOL谈话）和完成生前遗嘱/预先指示（AD）。在基线和3个月时进行测量。希望是用赫斯希望指数（HHI，范围12-48，分数越高表明希望越高）来衡量的。采用多变量回归来评估ACP和希望之间的关联，控制基线HHI评分、研究随机化和年龄、宗教重要性、教育程度、婚姻状况、社会经济地位、癌症诊断后的时间、疼痛/症状负担（ESAS）和焦虑/抑郁评分（HADS）——所有已知与ACP和/或希望相关的变量。总共有672名晚期癌症患者参加了整个研究。平均年龄为69±10岁，最常见的癌症类型为肺癌（36%）、胃肠道（20%）和乳腺/妇科（16%）。在该组中，378人（56%）在基线时没有进行EOL谈话，其中29%（111/378）报告在3个月时进行了EOL谈话。在研究期间，有或没有进行EOL对话的患者的希望没有差异（∆HHI 0.20±5.32 vs - 0.53±3.80,p=0.136）。多变量调整后，参与EOL对话的患者的希望显著增加（调整后的平均差异∆HHI为0.95 (95%CI 0.08-1.82), p=0.032）。同样，在216例（32%）基线时没有AD的患者中，31%（67/216）患者随后完成了AD。未调整的希望在已完成和未完成AD的患者之间没有差异（∆HHI 0.20±3.89 vs - 0.91±4.50,p=0.085）。调整后，完成AD的患者的希望明显更高（调整后的平均差异∆HHI为1.31 (95%CI 0.13-2.49), p=0.030）。我们的结果表明，参与ACP后，希望并没有减少，实际上可能会增加。这些发现可能为那些担心进行这些重要而困难的对话的临床医生提供安慰。参与预先护理计划的患者的希望并没有减少。提供者可以在不损害病人希望的情况下进行这些重要的对话。由于担心“放弃希望”，许多肿瘤学家推迟了预先护理计划（ACP）。我们的工作表明，无论是与肿瘤学家交谈还是完成预先指示，参与ACP的患者的希望都不会减少。有了这些信息，提供者可能会更放心地与患者进行这些重要的对话。
Clinicians often cite a fear of “giving up hope” as a reason they defer advance care planning (ACP) among patients with advanced cancer. We sought to determine whether engagement in ACP impacts patient’s hope. This is a secondary analysis of a randomized controlled trial of primary palliative care in advanced cancer. Patients who had not completed ACP at baseline were included in the analysis. ACP was assessed in the forms of an end-of-life conversation with one’s oncologist (EOL conversation) and completion of a living will/advance directive (AD). Measurements were obtained at baseline and 3 months. Hope was measured using the Herth Hope Index (HHI, range 12–48, higher scores indicate higher hope). Multivariate regression was performed to assess associations between ACP and hope, controlling for baseline HHI score, study randomization and age, religious importance, education, marital status, socioeconomic status, time since cancer diagnosis, pain/symptom burden (ESAS), and anxiety/depression score (HADS)—all variables known to be associated with ACP and/or hope. A total of 672 patients with advanced cancer were enrolled in the overall study. The mean age was 69±10, and the most common cancer types were lung (36%), GI (20%) and breast/GYN (16%). In this group, 378 (56%) had not had an EOL conversation at baseline, of whom 29% (111/378) reported having an EOL conversation by 3 months. Hope was not different between patients who had or did not have an EOL conversation over the study period (∆HHI 0.20 ± 5.32 vs −0.53 ± 3.80, p=0.136). After multivariable adjustment, hope was significantly increased in patients who had engaged in an EOL conversation (adjusted mean difference in ∆HHI 0.95 (95%CI 0.08–1.82), p=0.032). Similarly, of 216 (32%) patients without an AD at baseline, 31% (67/216) patients had subsequently completed one. Unadjusted hope was not different between those who had and had not completed an AD (∆HHI 0.20 ± 3.89 vs −0.91 ± 4.50, p=0.085). After adjustment, hope was significantly higher in those who completed an AD (adjusted mean difference in ∆HHI 1.31 (95%CI 0.13–2.49), p=0.030) Our results demonstrate that hope is not decreased after engagement in ACP and may, in fact, be increased. These findings may provide reassurance to clinicians who are apprehensive about having these important and difficult conversations. Hope is not decreased among patients who engage in advance care planning. Providers can have these important conversations without jeopardizing their patient’s hope. Many oncologists defer advance care planning (ACP) out of concern for “giving up hope.” Our work demonstrates that hope is not decreased in patients who have engaged in ACP either as a conversation with their oncologists or completion of an advance directive. With this information, providers may feel more comfortable having these important conversations with their patients.
登录
查看更多内容
影响因子：
3.2
作者：
Inoue, Megumi
通讯作者：
Inoue, Megumi
影响因子：
3.8
作者：
HERTH, K
通讯作者：
HERTH, K
影响因子：
3.1
作者：
Fischer, Ian C.;Cripe, Larry D.;Rand, Kevin L.
通讯作者：
Rand, Kevin L.
影响因子：
2.6
作者：
Chen, ML
通讯作者：
Chen, ML
影响因子：
4.7
作者：
Brown, Alaina J.;Shen, Megan Johnson;Bodurka, Diane C.
通讯作者：
Bodurka, Diane C.