Department of Internal Medicine I, Medical University, Vienna, Austria.
Wien Klin Wochenschr. 2010 Jan;122(1-2):45-9. doi: 10.1007/s00508-009-1295-3.
Oncologists differ widely in their attitudes towards palliative care and services. These attitudes depend on a number of individual and society-based variables. It is recommended that palliative care be started early in the disease trajectory of patients with a life-threatening disease but in Austria we lack data on oncologists' adherence to this recommendation. We surveyed 785 oncologists in Austria by presenting the clinical course of a hypothetical patient with primary metastatic breast cancer from diagnosis until death. The majority of oncologists would involve palliative care services when the patient's Karnofsky index (KI) was < 50, and hospice services when the KI was < 40. Special training in palliative care was significantly associated with early use of hospice services. Reasons for not involving palliative care and hospice services earlier than indicated were systematically evaluated and included, among others, "fear of destroying the patient's hopes" (36% of respondents with regard to palliative services, 57% with regard to hospices). Overall, 67% of the oncologists would inform the patient about the malignant nature of her disease and the anticipated limitation of her life expectancy at the time of diagnosis. Issuing an advance directive would be discussed by only 25% at that time. Our data show that oncologists involve palliative care services at an advanced stage of disease in patients with primary metastatic cancer and that information about malignancy and the incurable nature of the disease is not uniformly provided at the time of diagnosis.
肿瘤学家对姑息治疗和服务的态度差异很大。这些态度取决于许多个人和基于社会的变量。建议在危及生命的疾病患者的疾病轨迹早期开始姑息治疗，但在奥地利，我们缺乏关于肿瘤学家遵守这一建议的数据。我们通过呈现一位患有原发性转移性乳腺癌的假设患者的临床病程，对奥地利的 785 名肿瘤学家进行了调查，从诊断到死亡。大多数肿瘤学家会在患者的卡诺夫斯基指数（KI）<50 时引入姑息治疗服务，在 KI<40 时引入临终关怀服务。姑息治疗的特殊培训与早期使用临终关怀服务显著相关。不早于指示引入姑息治疗和临终关怀服务的原因被系统地评估，并包括“害怕破坏患者的希望”（36%的姑息服务受访者，57%的临终关怀受访者）。总体而言，67%的肿瘤学家会在诊断时告知患者其疾病的恶性性质和预期的预期寿命限制。只有 25%的人会在当时讨论提前指示。我们的数据表明，肿瘤学家在患有原发性转移性癌症的患者疾病晚期引入姑息治疗服务，并且在诊断时并不统一提供有关恶性肿瘤和疾病不可治愈性质的信息。
