Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06510, USA.
Gynecol Oncol. 2012 Mar;124(3):471-3. doi: 10.1016/j.ygyno.2011.09.029. Epub 2011 Oct 20.
To identify the practices and attitudes of gynecologic oncologists regarding the end-of-life discussion.
A pilot survey was sent to 1105 members of the Society of Gynecologic Oncologists (SGO). The survey consisted of 20 questions and was sent via the website Survey Monkey.
Response rate was 12.8%. Sixty percent of respondents were male, most ranged between 30 and 60 years of age and more than half performed 5-10 major surgeries per week. More than half of respondents (53.9%) deferred the End of Life discussion until the patient had sustained a major change in functional and/or medical status. Thirty percent initiated it at the first recurrence or progression of disease. Forty three percent of respondents characterized the discussion as an on-going process. Patients' age, social support, health insurance, and co-morbidities had no influence on the discussion, and neither did the tumor's site of origin or grade. More respondents initiated the discussion in advanced stage cancer (57%) and after salvage chemotherapy institution (54%). Forty four percent of respondents reported that "understanding and acceptance" was the initial response by patient when counseled about withdrawal of care. This increased to 86% when the issue was revisited. Confusion or reluctance to discuss the subject were initially reported to be 12% and 19%, respectively, but decreased to 2% and 3%, respectively, when withdrawal of care was subsequently addressed with the patient.
This pilot survey sheds a light on attitudes and practices about the end-of-life discussion that deserve to be further studied.
确定妇科肿瘤学家在临终讨论方面的实践和态度。
向妇科肿瘤学会（SGO）的 1105 名成员发送了一项试点调查。该调查由 20 个问题组成，并通过网站 Survey Monkey 发送。
回复率为 12.8%。60%的受访者为男性，年龄大多在 30 至 60 岁之间，每周进行 5-10 次大手术的人数超过一半。超过一半的受访者（53.9%）将临终讨论推迟到患者的功能和/或医疗状况发生重大变化后。30%的人在疾病第一次复发或进展时开始讨论。43%的受访者将讨论描述为一个持续的过程。患者的年龄、社会支持、医疗保险和合并症对讨论没有影响，肿瘤的起源部位或分级也没有影响。更多的受访者在晚期癌症（57%）和挽救性化疗后（54%）开始讨论。44%的受访者报告说，当患者接受关于停止治疗的咨询时，“理解和接受”是患者最初的反应。当再次讨论这个问题时，这一比例上升到 86%。最初有 12%和 19%的受访者表示对讨论该主题感到困惑或不愿意，但当随后与患者讨论停止治疗时，这一比例分别降至 2%和 3%。
这项试点调查揭示了关于临终讨论的态度和实践，值得进一步研究。
