Department of Investigational Cancer Therapeutics, Unit 0455, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
J Clin Oncol. 2012 Aug 10;30(23):2891-6. doi: 10.1200/JCO.2011.38.0758. Epub 2012 Jul 9.
Patients with advanced malignancies referred for early clinical trials have a short life expectancy. We designed this survey to ascertain the status of advance care planning in this population.
Patients who were seen in a phase I clinic were asked to anonymously complete an investigator-designed survey.
Of 435 individuals approached, 215 (49%) returned completed or partially completed surveys, whereas many others stated that they wanted to avoid the topic, because they had come to the phase I clinic for cancer therapy. Most patients (n = 149; 69%) were still hopeful about their future. Approximately 42% of patients (n = 90) reported having a living will, 46% had a medical power of attorney (n = 98), and 19% had a do-not-resuscitate (DNR) order (n = 40). Approximately 20% of participants (n = 43) had not discussed advance care planning. Fifty-nine percent of patients wanted to discuss advance care planning with their physician. Having a DNR order in place was significantly more common in individuals who had a living will and/or a medical power of attorney.
Although most patients referred to a phase I clinic remained optimistic, many had discussed a living will, medical power of attorney, and/or DNR order with their physician, family, and/or attorney. However, a significant minority had not addressed this issue with anyone, and many refused to take a survey on the topic. More than half of the patients wanted to discuss these matters with their physician. These observations suggest that extra effort to address advance care planning is needed for these patients.
被转介至早期临床试验的晚期恶性肿瘤患者预期寿命较短。我们设计了这项调查，以了解该人群的预先护理计划现状。
在 I 期临床诊所就诊的患者被要求匿名填写研究者设计的调查问卷。
在 435 名被调查者中，215 名（49%）人返回了完整或部分完成的调查问卷，而许多其他人则表示他们希望避免讨论这个话题，因为他们是来 I 期临床诊所接受癌症治疗的。大多数患者（n=149；69%）对未来仍抱有希望。约 42%的患者（n=90）报告称拥有生前预嘱，46%的患者（n=98）拥有医疗授权书，19%的患者（n=40）拥有不复苏（DNR）医嘱。约 20%的参与者（n=43）未讨论过预先护理计划。59%的患者希望与他们的医生讨论预先护理计划。有 DNR 医嘱的患者更可能拥有生前预嘱和/或医疗授权书。
尽管大多数被转介至 I 期临床诊所的患者仍保持乐观，但许多人已与他们的医生、家人和/或律师讨论过生前预嘱、医疗授权书和/或 DNR 医嘱。然而，仍有相当一部分人未与任何人讨论过这个问题，且许多人拒绝参与该主题的调查。超过一半的患者希望与他们的医生讨论这些问题。这些观察结果表明，这些患者需要额外努力来解决预先护理计划问题。
