Impact of high self-perceived burden to others with preferences for end-of-life care and its determinants for terminally ill cancer patients: a prospective cohort study
Impact of high self-perceived burden to others with preferences for end-of-life care and its determinants for terminally ill cancer patients: a prospective cohort study
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DOI：
10.1002/pon.4107
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发表时间：
2017-01-01
期刊：
影响因子：
3.6
通讯作者：
Hou, Ming-Mo
中科院分区：
文献类型：
--
作者：
Tang, Siew Tzuh;Hsieh, Chia-Hsun;Hou, Ming-Mo
背景/目的：自我感知他人负担（Self-perceived burden to others， SPB）是晚期癌症患者最关心的问题，并经常被纳入临终关怀（EOL）决策。然而，SPB的变化和决定因素及其对死亡过程中EOL护理偏好的纵向影响尚未被调查。我们的研究旨在填补这方面的知识空白。方法：对325例癌症患者进行随访，直至死亡。高SPB被认定为在自我感知负担量表上得分为bbb20。对EOL护理的偏好包括EOL护理目标、维持生命治疗和临终关怀。可能促成/减少患者高SPB的因素包括人口统计学、疾病特征和负担以及社会支持，并通过多元logistic回归模型与广义估计方程进行检验。结果：高SPB患病率随着死亡的临近而增加，分别在死亡前181 ~ 365天、91 ~ 180天、31 ~ 90天和1 ~ 30天分别为51.78%、58.26%、62.66%和65.38%。高SPB由女性、年轻、经济资源不足、无宗教信仰、患有严重的症状困扰和严重的功能依赖促成，但与患者死亡时间、疾病特征和社会支持无关。此外，高SPB与eol护理偏好无关，无论是积极的维持生命治疗还是临终关怀。结论：高SPB在晚期癌症患者中普遍存在，但与EOL护理的偏好无关。癌症患者的SPB可以通过适当的症状缓解来减轻，以促进功能独立性。这些缓解SPB的策略可能会改善死亡和临终的质量。版权所有：John Wiley & Sons， Ltd。
Background/Objective: Self-perceived burden to others (SPB) is a major concern of terminally ill cancer patients and is frequently factored into end-of-life (EOL) care decision-making. However, changes in and determinants of SPB and its longitudinal impact on preferences for EOL care over the dying process have not been investigated. Our study was aimed at filling this gap in knowledge.Methods: A convenience sample of 325 cancer patients was followed until death. High SPB was identified as scoring >20 on the Self-perceived Burden Scale. Preferences for EOL care included EOL-care goals, life-sustaining treatments, and hospice care. Factors potentially precipitating/minimizing patients' high SPB included demographics, disease characteristics and burden, and social support and were examined by multivariate logistic regression modeling with the generalized estimating equation.Results: Prevalence of high SPB increased as death approached (51.78%, 58.26%, 62.66%, and 65.38% for 181-365, 91-180, 31-90, and 1-30 days before death, respectively). High SPB was precipitated by women, younger age, having inadequate financial resources, without religious affiliation, and suffering from severe symptom distress and heavy functional dependence but was independent of time proximity to patient death, disease characteristics, and social support. Furthermore, high SPB was not associated with EOL-care preferences, whether aggressive life-sustaining treatments or hospice care.Conclusions: High SPB was prevalent among terminally ill cancer patients but independent of preferences for EOL care. Cancer patients' SPB may be lessened by adequate symptom relief to facilitate functional independence. These strategies to ease SPB may improve the quality of death and dying. Copyright (C) 2016 John Wiley & Sons, Ltd.