Physician's Communication in Code Status Discussions for Terminally Ill Cancer Patients in Inpatient Hospice/Palliative Care Units in Japan: A Nationwide Post-Bereavement Survey
Physician's Communication in Code Status Discussions for Terminally Ill Cancer Patients in Inpatient Hospice/Palliative Care Units in Japan: A Nationwide Post-Bereavement Survey
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DOI：
10.1016/j.jpainsymman.2021.03.011
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发表时间：
2021-08-30
影响因子：
4.7
通讯作者：
Miyashita, Mitsunori
中科院分区：
文献类型：
--
作者：
Kizawa, Yoshiyuki;Yamaguchi, Takashi;Miyashita, Mitsunori
上下文心脏复苏是最重要的临终关怀决定之一。然而，在代码状态讨论期间失去亲人的家庭的经历没有得到很好的记录。本研究的目的是描述丧亲家庭在讨论代码状态时的情绪困扰程度，确定他们认为需要改进的领域并确定相关因素。这项研究是一项全国性的丧亲后调查的一部分，日本临终关怀和姑息治疗评估3（J-HOPES）研究。2014年，在日本的姑息治疗病房中死亡的癌症患者的亲属收到了这些信件。在对338份调查问卷的分析中，37%的家庭在讨论代码状态时报告了高度的情绪困扰，32%的家庭报告需要改进。多元逻辑回归分析显示，以下因素与高水平的痛苦有关：病人的家人曾希望病人奇迹般地自然康复。（比值比[OR] 2.4，95%置信区间[CI] 1.31-4.43，P= 0.0049），家属认为他们无法表达对心肺复苏的意见（OR 2.07，CI 1.12-3.81，P= 0.02），或医生未能根据家庭准备水平调整解释（OR 0.36，CI 0.18-0.68，P= 0.0015）。改善的因素有：在轻松的气氛中进行讨论，有利于提问（OR 0.36，CI 0.16-0.80，P= 0.012），确保医生根据家属的准备水平进行解释（OR 0.47，CI 0.23-0.96，P= 0.037）。我们建议开发代码状态讨论的教育计划，以改善失去亲人的家庭成员的体验。(C)2021美国临终关怀和姑息医学学院。爱思唯尔公司出版All rights reserved.
Context. Cardiopulmonary resuscitation is one of the most important end-of-life care decisions. However, the experience of bereaved families during code status discussions is not well documented.Objective. The aims of this study were to describe the degree of emotional distress of bereaved families when discussing code status, identify their perceived areas for improvement and determine associated factors.Methods. This study is part of a nationwide post-bereavement survey, the Japan Hospice and Palliative care Evaluation 3 (J-HOPES) study. Questionnaires were sent to the relatives of cancer patients who had died in palliative care units in Japan in 2014.Results. From an analysis of 338 questionnaires, 37% of families reported high emotional distress during code status discussions and 32% reported a need for improvement. Multiple logistic regression analyses revealed the following were associated with high-level distress: the family had hoped for the miraculous and spontaneous recovery of the patient (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.31-4.43, P= 0.0049), the family felt they could not voice their opinion about Cardiopulmonary resuscitation (OR 2.07, CI 1.12-3.81, P= 0.02), or the physician failed to adapt the explanation to the family's preparation level (OR 0.36, CI 0.18-0.68, P= 0.0015). Factors identified for improvement were: holding discussions in a relaxing atmosphere conducive to questioning (OR 0.36, CI 0.16-0.80, P= 0.012), and ensuring the physician adapted the explanation to the family's preparation level (OR 0.47, CI 0.23-0.96, P= 0.037).Conclusion. We recommend the development of educational programs for code status discussions to improve the experience of bereaved family members. (C) 2021 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.