Considerations about hastening death among parents of children who die of cancer.
Considerations about hastening death among parents of children who die of cancer.
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DOI：
10.1001/archpediatrics.2009.295
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发表时间：
2010-03
影响因子：
--
通讯作者：
Wolfe J
中科院分区：
文献类型：
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作者：
Dussel V;Joffe S;Hilden JM;Watterson-Schaeffer J;Weeks JC;Wolfe J
估计加速死亡讨论的频率，描述当前父母对加速死亡和强化症状管理的认可，并探讨孩子的疼痛是否会影响孩子死于癌症的父母样本中的这些观点。横截面调查。两家美国三级护理儿科机构。141名死于癌症的儿童的父母（应答率64%）。在描绘晚期癌症儿童的小插曲中，（1）考虑或（2）讨论过在生命结束时加速死亡，以及（3）赞同加速死亡或（4）强化症状管理的父母比例。141名家长中有19名（13%; 95%可信区间[CI]，8%-19%）考虑过要求孩子加速死亡，9%（95%可信区间，4%-14%）的家长讨论过加速死亡;考虑加速死亡的倾向随着孩子疼痛程度的增加而增加。回顾过去，34%（95%CI，26%-42%）的父母报告说，如果孩子处于无法控制的疼痛中，他们会考虑加速孩子的死亡，而15%或更少的人会考虑加速非身体痛苦的死亡。在对小插曲的回应中，50%（95%CI，42%-58%）的父母赞成加速死亡，而94%（95%CI，90%-98%）的父母赞成强化疼痛管理。与昏迷儿童相比，如果小插曲涉及儿童疼痛，则父母更可能支持加速死亡（比值比，1.4; 95%CI，1.1 - 1.8）。超过10%的父母认为加速他们的孩子的死亡，这是更有可能的，如果孩子在痛苦中。对疼痛和痛苦的关注，以及关于强化症状管理的教育可能会减轻癌症儿童父母对加速死亡的考虑。
To estimate the frequency of hastening death discussions, describe current parental endorsement of hastening death and intensive symptom management, and explore whether child’s pain influences these views among a sample of parents whose child died of cancer. Cross-sectional survey. Two tertiary-care US pediatric institutions. 141 parents of children who died of cancer (response rate 64%). Proportion of parents who (1)considered or (2)discussed hastening death during the end-of-life, and (3)who endorsed hastening death or (4)intensive symptom management in vignettes portraying children with end-stage cancer. a total of 19 out of 141, (13%; 95% confidence interval [CI], 8%–19%) parents considered requesting hastening death for their child, and 9% (95%CI, 4%–14%) discussed hastening death; consideration of hastening death tended to increase with increasing child suffering from pain. In retrospect, 34% (95%CI, 26%–42%) of parents reported they would have considered hastening their child’s death had the child been in uncontrollable pain, while 15% or less would consider hastening death for non-physical suffering. In response to vignettes, 50% (95%CI, 42%–58%) of parents endorsed hastening death while 94% (95%CI, 90%–98%) endorsed intensive pain management. Parents were more likely to endorse hastening death if the vignette involved a child in pain as compared to in coma (odds ratio, 1.4; 95%CI, 1.1–1.8). More than 10% of parents considered hastening their child’s death and this was more likely if the child was in pain. Attention to pain and suffering, and education about intensive symptom management may mitigate consideration of hastening death among parents of children with cancer.