Cherny Nathan I, Catane Raphael
Medical Oncology and Palliative Medicine Service, Department of Oncology, Shaare Zedek Medical Center, Jerusalem, Israel.
Cancer. 2003 Dec 1;98(11):2502-10. doi: 10.1002/cncr.11815.
In part of a quality improvement program, the European Society of Medical Oncology (ESMO) surveyed its membership regarding their involvement in and attitudes toward the palliative care (PC) of patients with advanced cancer.
Of 895 members who responded, 82.5% were European and 12.1% were American. Sixty-nine percent of respondents reported that patients with advanced cancer constituted a major proportion of their practice; for 22% of respondents, patients with advanced cancer constituted most of their practice. Only a minority of respondents collaborated often with a PC care specialist (35%), a palliative home care service (38%), an in-patient hospice (26%), or a psychologist (33%). In response to questions regarding specific involvement in PC clinical tasks, respondents were involved more commonly in treating physical symptoms, such as pain (93%), fatigue (84%), and nausea/emesis (84%), than in managing psychological symptoms and end-of-life care issues, such as depression/anxiety (65%), existential distress (29%), or delirium (12%). Forty-three percent of respondents reported that they directly administered end-of-life care often, and 74% reported that they derived satisfaction from their involvement in end-of-life care. Overall, 88.4% of respondents endorsed the belief that medical oncologists should coordinate the end-of-life care for their patients, but a substantial minority (42%) felt that they were trained inadequately for this task. Positive attitudes toward PC were correlated highly with the degree of direct involvement in PC practice. Practitioners in private practice or teaching hospitals had substantially more positive attitudes regarding PC compared with physicians based in comprehensive cancer centers (P < 0.05). Although most of the responding medical oncologists expressed positive views regarding their involvement in the PC of patients with advanced cancer and dying patients, 15% of respondents had pervasively negative views.
Most ESMO oncologists recognize the importance of PC and supportive care for patients with advanced cancer. Despite this, many are prepared inadequately for these tasks, and actual participation levels commonly are suboptimal.
作为质量改进计划的一部分，欧洲医学肿瘤学会（ESMO）对其成员就他们对晚期癌症患者姑息治疗（PC）的参与情况和态度进行了调查。
在895名回复的成员中，82.5%是欧洲人，12.1%是美国人。69%的受访者报告称晚期癌症患者占其业务的很大比例；对于22%的受访者来说，晚期癌症患者占其业务的大部分。只有少数受访者经常与姑息治疗护理专家（35%）、姑息家庭护理服务机构（38%）、住院临终关怀机构（26%）或心理医生（33%）合作。在回答关于具体参与姑息治疗临床任务的问题时，受访者更常参与治疗身体症状，如疼痛（93%）、疲劳（84%）和恶心/呕吐（84%），而不是管理心理症状和临终关怀问题，如抑郁/焦虑（65%）、存在性痛苦（29%）或谵妄（12%）。43%的受访者报告称他们经常直接提供临终关怀，74%的受访者报告称他们从参与临终关怀中获得了满足感。总体而言，88.4%的受访者认可肿瘤内科医生应该为其患者协调临终关怀的观点，但相当一部分少数人（42%）觉得他们在这项任务上的培训不足。对姑息治疗的积极态度与直接参与姑息治疗实践的程度高度相关。与综合癌症中心的医生相比，私人执业或教学医院的从业者对姑息治疗的态度明显更积极（P < 0.05）。尽管大多数回复的肿瘤内科医生对他们参与晚期癌症患者和临终患者的姑息治疗表达了积极看法，但15%的受访者持普遍负面看法。
大多数ESMO肿瘤学家认识到姑息治疗和支持性护理对晚期癌症患者的重要性。尽管如此，许多人对这些任务准备不足，实际参与水平通常不理想。
