Wentlandt Kirsten, Burman Debika, Swami Nadia, Hales Sarah, Rydall Anne, Rodin Gary, Lo Christopher, Zimmermann Camilla
Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Canada.
Psychooncology. 2012 Aug;21(8):868-76. doi: 10.1002/pon.1995. Epub 2011 Jun 5.
Previous studies regarding patients' end of life (EOL) preparation have focused mainly on practical tasks, such as advance directives. In this study, we investigate the relational and personal aspects of EOL preparation, using a patient-completed questionnaire, and examine associations with clinician-patient communication (CPC) and other variables.
Patients with advanced cancer but with good performance status were recruited from 24 medical oncology clinics, to participate in a cluster-randomised controlled trial of early palliative care intervention. Measures included the Quality of Life at the End of Life preparation for EOL subscale, and measures of CPC, functional status, comorbidity, spiritual well-being and symptom severity. Using chi-squared tests, t-tests and multivariate regression analyses, we examined the variables associated with preparation for EOL. We also examined the frequency distributions of individual EOL preparation items and used logistic regression to examine their associations with adequacy of CPC.
In the 469 patients, characteristics associated with better EOL preparation were better CPC, older age, living alone, less symptom burden and better spiritual well-being. Thirty-one per cent agreed that they worried 'quite a bit' or 'completely' about their family's preparation to cope with the future, and 27% agreed that they would be a burden to their family. All preparation items except regrets about life were associated with adequacy of communication.
A substantial minority of patients with advanced cancer but with good performance status are concerned about EOL preparation, particularly in relation to their families. Better CPC may help patients prepare not only practically but also personally and socially in relation to the dying process and the welfare of their families.
以往关于患者临终准备的研究主要集中在实际任务方面，如预先指示。在本研究中，我们使用患者填写的问卷来调查临终准备的关系和个人方面，并检验其与医患沟通（CPC）及其他变量的关联。
从24家肿瘤内科诊所招募病情晚期但身体状况良好的患者，参与一项早期姑息治疗干预的整群随机对照试验。测量指标包括临终生活质量量表中的临终准备子量表，以及医患沟通、功能状态、合并症、精神健康和症状严重程度的测量指标。我们使用卡方检验、t检验和多元回归分析来检验与临终准备相关的变量。我们还检查了各个临终准备项目的频率分布，并使用逻辑回归来检验它们与医患沟通充分性的关联。
在469名患者中，与更好的临终准备相关的特征包括更好的医患沟通、年龄较大、独居、症状负担较轻和精神健康状况较好。31%的患者表示他们“相当”或“完全”担心家人应对未来的准备情况，27%的患者表示他们会成为家人的负担。除了对生活的遗憾之外，所有准备项目都与沟通的充分性相关。
相当一部分病情晚期但身体状况良好的患者担心临终准备，尤其是与家人相关的方面。更好的医患沟通可能有助于患者不仅在实际方面，而且在个人和社会层面为死亡过程及其家人的福祉做好准备。
