Georges Jean-Jacques, Onwuteaka-Philipsen Bregje D, van der Heide Agnes, van der Wal Gerrit, van der Maas Paul J
Department of Public and Occupational Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
J Pain Symptom Manage. 2006 Feb;31(2):100-10. doi: 10.1016/j.jpainsymman.2005.06.013.
This study investigates the background and evolution of requests to forgo treatment and hasten death in terminally ill cancer patients. Physicians participating in a nationwide study on end-of-life decision making were asked whether they were treating a terminally ill cancer patient whose life expectancy was longer than 1 week but no longer than 3 months and who they would continue to treat until the patient's death. Of the 120 physicians who had a patient who met the inclusion criteria, 85 (70.8%) completed a questionnaire each month until the patient's death. The questionnaire provided information on the patient's symptoms, concerns, and requests involving end-of-life decisions. Most patients suffered from cancer of the gastrointestinal tract or the respiratory system, and 66% died within 2 months of the initial interview. The prevalence of requests involving end-of-life decisions increased during the last 3 months of a patient's life. The evolution of a request was especially related to an increase in the number of severe symptoms and concerns. Requests to forgo treatment were related to general weakness, whereas loss of dignity was a major reason for requests to hasten death. Physical suffering alone appeared to lead to less drastic requests than suffering blended by concerns and psychological problems leading to requests for hastened death. The results emphasize the importance of gaining insight into the patients' suffering to provide meaningful assistance.
本研究调查了晚期癌症患者放弃治疗并加速死亡请求的背景和演变情况。参与一项全国性临终决策研究的医生被问及他们是否正在治疗一名预期寿命超过1周但不超过3个月的晚期癌症患者，以及他们是否会继续治疗该患者直至其死亡。在120名有符合纳入标准患者的医生中，85名（70.8%）每月填写一份问卷，直至患者死亡。该问卷提供了有关患者症状、担忧以及涉及临终决策请求的信息。大多数患者患有胃肠道或呼吸系统癌症，66%在初次访谈后的2个月内死亡。涉及临终决策请求的发生率在患者生命的最后3个月有所增加。请求的演变尤其与严重症状和担忧数量的增加有关。放弃治疗的请求与全身虚弱有关，而尊严丧失是加速死亡请求的主要原因。单纯的身体痛苦似乎比由担忧和心理问题交织导致加速死亡请求的痛苦引发的极端请求要少。研究结果强调了深入了解患者痛苦以提供有意义帮助的重要性。
