National Institute of Cancer Research, National Health Research Institutes, Miaoli County, Taiwan.
Oncologist. 2009 Dec;14(12):1232-41. doi: 10.1634/theoncologist.2009-0095. Epub 2009 Dec 10.
Oncologists play a significant role in cancer care throughout the cancer trajectory and have traditionally emphasized underuse of procedures/treatments with well-established effectiveness as the source of poor care quality with little attention to overusing end-of-life (EOL) care. The purpose of this population-based study was to compare the quality of EOL care between medical oncologists and other physician specialists.
This retrospective cohort study compared indicators of poor quality EOL care by examining administrative data for 204,850 Taiwanese cancer decedents in 2001-2006.
Taiwanese cancer patients whose primary physician was a medical oncologist were significantly more likely than patients of other physician specialists to receive chemotherapy and to spend >14 days in a hospital in the last month of life. However, they were significantly less likely than patients of other physician specialists to visit the emergency room (ER) more than once and to use intensive care unit (ICU) care, cardiopulmonary resuscitation (CPR), intubation, and mechanical ventilation in the last month of life.
The quality of EOL cancer care in Taiwan varied significantly by physician specialty. Cancer decedents cared for by medical oncologists were more likely to receive chemotherapy and prolonged hospitalization but less likely to have multiple ER visits, ICU care, or undergo CPR, intubation, or mechanical ventilation in the last month of life than patients of other physician specialists.
肿瘤学家在癌症治疗的全过程中扮演着重要的角色，他们传统上强调对具有良好疗效的程序/治疗方法的使用不足是导致治疗质量差的原因，而对临终关怀的过度使用关注较少。本基于人群的研究旨在比较肿瘤医生和其他专科医生在临终关怀质量方面的差异。
本回顾性队列研究通过对 2001 年至 2006 年间 204850 名台湾癌症死亡患者的行政数据进行检查，比较了临终关怀质量差的指标。
与其他专科医生的患者相比，台湾癌症患者的主要医生是肿瘤医生的患者在生命的最后一个月接受化疗和在医院住院超过 14 天的可能性显著更高。然而，他们在生命的最后一个月去急诊室（ER）就诊超过一次、使用重症监护病房（ICU）护理、心肺复苏（CPR）、插管和机械通气的可能性显著低于其他专科医生的患者。
台湾临终关怀癌症护理的质量因医生专业而异。由肿瘤医生治疗的癌症死亡患者更有可能接受化疗和延长住院时间，但在生命的最后一个月，他们更不可能多次去急诊室就诊、接受 ICU 护理或进行 CPR、插管或机械通气，而其他专科医生的患者则更有可能。
