Ozanne Elissa M, Partridge Ann, Moy Beverly, Ellis Katherine J, Sepucha Karen R
Institute for Technology Assessment, Massachusetts General Hospital, Boston, USA.
J Palliat Med. 2009 Jun;12(6):547-53. doi: 10.1089/jpm.2008.0254.
Oncology providers often find it difficult to discuss end-of-life issues with patients and assume that patients are reluctant to think about the issues involved. This study examined whether or not patients with metastatic breast cancer had advance directives, and if so, with whom they discussed written plans for end-of-life decisions.
A cross-sectional sample of 32 women with metastatic breast cancer and their providers from two academic medical centers in the United States were surveyed at baseline and again 3 months later about advance directives, decision-making goals, and their expectations. After the baseline assessment, patients viewed a decision aid that discussed choices for treatment of metastatic disease. The patients' experience with advance directives in addition to associations between advance directives and patient preferences regarding end-of-life care, demographics, and clinical characteristics were analyzed.
At baseline, the majority of women had gathered information (75%) about or had written (66%) advance directives. These percentages increased at 3 months. Providers were only aware of the presence of an advance directive in a minority of cases (14%). Patients were more than three times as likely to talk to and share written plans with family and friends than with their providers.
The majority of patients gathered information about advance directives and had made written plans, yet few discussed these plans with their providers. Explicit discussion of advance directives and patient preferences regarding end-of-life care are lacking in this setting. Facilitation of doctor-patient communication about end-of-life care is needed in order to provide quality patient care at this difficult time.
肿瘤学医疗服务提供者常常发现很难与患者讨论临终问题，并认为患者不愿思考其中涉及的问题。本研究调查了转移性乳腺癌患者是否有预先指示，如果有，他们与谁讨论过临终决策的书面计划。
对来自美国两个学术医疗中心的32名转移性乳腺癌女性患者及其医疗服务提供者进行横断面抽样调查，在基线时以及3个月后再次调查预先指示、决策目标和他们的期望。在基线评估后，患者观看了一个决策辅助工具，该工具讨论了转移性疾病的治疗选择。分析了患者在预先指示方面的经历，以及预先指示与患者在临终护理、人口统计学和临床特征方面的偏好之间的关联。
在基线时，大多数女性已经收集了有关预先指示的信息（75%）或已经撰写了预先指示（66%）。这些百分比在3个月时有所增加。医疗服务提供者仅在少数情况下（14%）知晓预先指示的存在。患者与家人和朋友谈论并分享书面计划的可能性是与医疗服务提供者的三倍多。
大多数患者收集了有关预先指示的信息并制定了书面计划，但很少与他们的医疗服务提供者讨论这些计划。在这种情况下，缺乏对预先指示和患者在临终护理方面的偏好的明确讨论。在这个困难时期，需要促进医患之间关于临终护理的沟通，以便提供高质量的患者护理。
