A descriptive analysis of end-of-life discussions for high-grade glioma patients
A descriptive analysis of end-of-life discussions for high-grade glioma patients
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DOI：
10.1093/nop/npab010
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发表时间：
2021-03-10
影响因子：
2.7
通讯作者：
Nin，Kazuko
中科院分区：
文献类型：
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作者：
Chikada，Ai;Takenouchi，Sayaka;Nin，Kazuko
背景高级别胶质瘤(HGG)患者的临终讨论(EOLDs)尚未得到很好的描述。因此，本研究探讨EOLD的适宜性和患者参与的程度及其对HGG患者的影响。方法于2019年7月至8月在日本一所大学医院对105名HGG患者的丧亲家庭进行横断面调查。结果共回收77份问卷，应答率为73%，其中20人回复了拒绝文件。总体而言，31/57人(54%)在急性医院环境中至少参加了一次EOLD，在向家人传达患者对EOL护理的意愿方面，参与组和非参与组之间存在显著差异(48%对8%，P=.001)。此外，80%的受访者表示，在患者和家属的早期诊断期间启动EOLDs是合适的。大多数EOLD是由神经外科医生(96%)提供的，其他医疗保健提供者很少参与。此外，只有28%的EOLD讨论了患者的目标和优先事项。患者参与EOLDs与EOL护理的质量和良好的死亡率无关。结论尽管EOLDs的参与对HGG患者来说是相对具有挑战性的，但本研究表明参与EOLDs可能使患者能够表达他们对EOL护理的意愿。在尊重患者目标和优先顺序的同时，通过跨学科团队方法在早期启动EOLD是很重要的。
BackgroundEnd-of-life discussions (EOLDs) in patients with high-grade glioma (HGG) have not been well described. Therefore, this study examined the appropriateness of timing and the extent of patient involvement in EOLDs and their impact on HGG patients.MethodsA cross-sectional survey was conducted among 105 bereaved families of HGG patients at a university hospital in Japan between July and August 2019. Fisher’s exact test and the Wilcoxon rank-sum test were used to assess the association between patient participation in EOLDs and their outcomes.ResultsIn total, 77 questionnaires were returned (response rate 73%), of which 20 respondents replied with refusal documents. Overall, 31/57 (54%) participated in EOLDs at least once in acute hospital settings, and a significant difference was observed between participating and nonparticipating groups in communicating the patient’s wishes for EOL care to the family (48% vs 8%,P= .001). Moreover, >80% of respondents indicated that the initiation of EOLDs during the early diagnosis period with patients and families was appropriate. Most EOLDs were provided by neurosurgeons (96%), and other health care providers rarely participated. Additionally, patient goals and priorities were discussed in only 28% of the EOLDs. Patient participation in EOLDs was not associated with the quality of EOL care and a good death.ConclusionsAlthough participation in EOLDs is relatively challenging for HGG patients, this study showed that participation in EOLDs may enable patients to express their wishes regarding EOL care. It is important to initiate EOLDs early on through an interdisciplinary team approach while respecting patient goals and priorities.