Proxy perspectives regarding end-of-life care for persons with cancer
Proxy perspectives regarding end-of-life care for persons with cancer
复制标题
DOI：
10.1002/cncr.23381
复制
发表时间：
2008-04-15
期刊：
影响因子：
6.2
通讯作者：
Hegel, Mark T.
中科院分区：
文献类型：
--
作者：
Bakitas, Marie;Ahles, Tim A.;Hegel, Mark T.
背景在美国，每年有超过50万人死于癌症。尽管在增加获得姑息性肿瘤学服务方面取得了进展，但临终关怀仍需改进。衡量生命终结体验的质量是困难的，因为随着死亡的临近，患者虚弱和意识下降。家庭代理人已被提议作为关于临终关怀质量的宝贵信息提供者。本文介绍了家庭代理的观点有关照顾在生命的最后谁死于晚期癌症的患者。在一个新的门诊姑息治疗示范项目的背景下，125名家庭代理受访者完成了一个结构化的调查，通过电话3个月至6个月后，病人死于乳腺癌，肺癌，或胃肠道癌症。四个关键的护理质量指标进行了测量：决策和医生沟通，死亡的位置，临终关怀的参与，并结束了生命的关怀。代理人报告说，78%至81%的患者完成了至少一种形式的预先指示，其中约一半有助于指导护理。在67%的病例中，与医生就临终治疗的愿望进行了沟通，但只有57%的患者实际上与医生制定了计划，以确保他们的愿望得到遵循。大多数患者在他们选择的地点死亡，最常见的是在家中，超过一半的患者在死亡前平均41.8天参与临终关怀。在生命的最后一周，大多数患者经历了令人烦恼的身体和情绪困扰。代理观点的测量作为临终关怀质量的指标是可行的，目前研究的结果为姑息肿瘤治疗的改进领域提供了可操作的数据。
BACKGROUND. Each year, greater than a half million people die of cancer in the U.S. Despite progress in increasing access to palliative oncology services, end-of-life care still needs improvement. Measuring the quality of the end-of-life experience is difficult because of patient debility and reduced consciousness as death approaches. Family proxies have been proposed as valuable informants regarding the quality of end-of-life care. This article describes family proxy perspectives concerning care at the end of life in patients who died of advanced cancer.METHODS. in the context of a novel outpatient palliative care demonstration project, 125 family proxy respondents completed a structured survey by telephone 3 months to 6 months after the patient's death from breast, lung, or gastrointestinal cancer. Four key quality of care indicators were measured: decision-making and physician communication, location of death, hospice involvement, and end-of-life symptoms.RESULTS. Proxies reported that 78% to 81% of patients completed at least I form of advance directive and approximately half of them were helpful in guiding care. Communication with physicians regarding end-of-life treatment wishes occurred in 67% of cases, but only 57% of the patients actually made a plan with their physician to ensure that their wishes were followed. The majority of patients died in their location of choice, most often at home, and greater than half had hospice involvement for an average of 41.8 days before death. During the last week of life, the majority of patients experienced troublesome physical and emotional symptoms.CONCLUSIONS. Measurement of proxy perspectives is feasible as an indicator of the quality of end-of-life care, and the results of the current study provide actionable data for areas of improvement in palliative oncology care.