Ford Dee W, Nietert Paul J, Zapka Jane, Zoller James S, Silvestri Gerard A
Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina29425, USA.
Palliat Support Care. 2008 Dec;6(4):357-62. doi: 10.1017/S1478951508000564.
Most patients diagnosed with lung cancer present with advanced stage disease and have a poor chance of long-term survival. Despite the advantages of hospice care for lung cancer patients, many are enrolled late in the course of their illness or not at all. We sought to identify reasons for this pattern.
A list of perceived barriers to hospice enrollment was generated and used to create two self-administered surveys, one for physicians and one for caregivers. After focus group testing, the finalized instruments were mailed to physicians in South Carolina and to caregivers of lung cancer patients who died under hospice care with a local hospice between 2000 and 2004.
Fifty-three caregivers and 273 physicians responded to the survey. From the caregivers' perspectives, leading reasons for deferred hospice enrollment included patients' unanticipated rapid transition from well to sick and a belief that hospice means giving up hope. From the physicians' perspectives, impediments to earlier hospice enrollment included patients and caregivers overestimating survival from lung cancer and an (incorrect) assumption that patients need to be "DNR/DNI" prior to hospice enrollment.
Lung cancer patients may benefit from earlier introduction to the concepts of hospice care and more education regarding prognosis so that an easier transition in goals of care could be achieved. A smaller proportion of lung cancer patients may benefit from earlier hospice enrollment.
大多数被诊断为肺癌的患者就诊时已处于疾病晚期，长期存活的机会渺茫。尽管临终关怀对肺癌患者有诸多益处，但许多患者在病程后期才登记接受临终关怀，或者根本未登记。我们试图找出这种模式的原因。
列出一系列被认为是临终关怀登记障碍的因素，并据此创建了两份自填式调查问卷，一份针对医生，一份针对护理人员。经过焦点小组测试后，将最终确定的问卷邮寄给南卡罗来纳州的医生以及2000年至2004年间在当地临终关怀机构接受临终关怀去世的肺癌患者的护理人员。
53名护理人员和273名医生回复了调查问卷。从护理人员的角度来看，临终关怀登记延迟的主要原因包括患者从健康到患病的意外快速转变以及认为临终关怀意味着放弃希望。从医生的角度来看，早期临终关怀登记的障碍包括患者和护理人员高估肺癌患者的生存期，以及（错误地）认为患者在登记接受临终关怀之前需要“放弃心肺复苏/不使用生命支持”。
肺癌患者可能会从更早地了解临终关怀概念以及更多关于预后的教育中受益，从而更轻松地实现护理目标的转变。一小部分肺癌患者可能会从更早登记接受临终关怀中受益。
