Huskamp Haiden A, Keating Nancy L, Malin Jennifer L, Zaslavsky Alan M, Weeks Jane C, Earle Craig C, Teno Joan M, Virnig Beth A, Kahn Katherine L, He Yulei, Ayanian John Z
Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115, USA.
Arch Intern Med. 2009 May 25;169(10):954-62. doi: 10.1001/archinternmed.2009.127.
Many terminally ill patients enroll in hospice only in the final days before death or not at all. Discussing hospice with a health care provider could increase awareness of hospice and possibly result in earlier use.
We used data on 1517 patients diagnosed as having stage IV lung cancer from a multiregional study. We estimated logistic regression models for the probability that a patient discussed hospice with a physician or other health care provider before an interview 4 to 7 months after diagnosis as reported by either the patient or surrogate or documented in the medical record.
Half (53%) of the patients had discussed hospice with a provider. Patients who were black, Hispanic, non-English speaking, married or living with a partner, Medicaid beneficiaries, or had received chemotherapy were less likely to have discussed hospice. Only 53% of individuals who died within 2 months after the interview had discussed hospice, and rates were lower among those who lived longer. Patients who reported that they expected to live less than 2 years had much higher rates of discussion than those expecting to live longer. Patients reporting the most severe pain or dyspnea were no more likely to have discussed hospice than those reporting less severe or no symptoms. A third of patients who reported discussing do-not-resuscitate preferences with a physician had also discussed hospice.
Many patients diagnosed as having metastatic lung cancer had not discussed hospice with a provider within 4 to 7 months after diagnosis. Increased communication with physicians could address patients' lack of awareness about hospice and misunderstandings about prognosis.
许多晚期患者仅在临终前几天才加入临终关怀项目，或者根本未加入。与医疗服务提供者讨论临终关怀事宜可能会提高对临终关怀的认知，并可能促使更早地使用该服务。
我们使用了一项多区域研究中1517例被诊断为IV期肺癌患者的数据。我们估计了逻辑回归模型，以计算患者在诊断后4至7个月接受访谈前，与医生或其他医疗服务提供者讨论临终关怀的概率，该概率由患者或代理人报告，或记录在病历中。
一半（53%）的患者与医疗服务提供者讨论过临终关怀。黑人、西班牙裔、非英语使用者、已婚或与伴侣同住、医疗补助受益人或接受过化疗的患者讨论临终关怀的可能性较小。在访谈后2个月内死亡的患者中，只有53%讨论过临终关怀，存活时间较长的患者比例更低。报告预期寿命不到2年的患者讨论临终关怀的比例远高于预期寿命更长的患者。报告最严重疼痛或呼吸困难的患者与报告症状较轻或无症状的患者相比，讨论临终关怀的可能性并无增加。三分之一报告与医生讨论过不进行心肺复苏偏好的患者也讨论过临终关怀。
许多被诊断为转移性肺癌的患者在诊断后4至7个月内未与医疗服务提供者讨论过临终关怀。加强与医生的沟通可以解决患者对临终关怀缺乏认识以及对预后存在误解的问题。
