Kim Seon-Young, Kim Jae-Min, Kim Sung-Wan, Shin Il-Seon, Bae Kyung-Yeol, Shim Hyun-Jeong, Hwang Jun-Eul, Bae Woo-Kyun, Cho Sang-Hee, Chung Ik-Joo, Yoon Jin-Sang
Mental Health Clinic, Chonnam National University Hwasun Hospital, Hwasun, Korea.
Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea.
Psychooncology. 2013 Oct;22(10):2206-13. doi: 10.1002/pon.3275. Epub 2013 Mar 15.
Clinical studies, with a proper scientific design, on the impact of disclosing a prognosis on a patient's psychological or physical conditions are rare. We investigated the effect of patient awareness of terminal status on survival and quality of life (QoL) in a palliative care setting.
This is a prospective cohort study of patients with terminal cancer. Patients with cancer at a palliative care unit were enrolled consecutively. The patients' awareness of their terminal status was determined using a semistructured interview. Sociodemographic and clinical characteristics, including Eastern Cooperative Oncology Group performance status, depressed mood, and QoL, were investigated. To determine the independent effects of awareness of illness on survival and QoL, multivariate Cox proportional-hazards regression and multivariate linear regression were used, respectively.
For the 262 cases analyzed, the median survival time (interquartile range) was 28.5 (15.8-55.3) days, and 76 (29.0%) patients were unaware of their prognosis. Patients who were aware survived for a shorter period than did those who were unaware (HR, 1.44; 95% CI, 1.07-1.93, p = 0.015) after adjusting for clinical variables including physical status and depression. Also, patients who were aware reported lower subjective QoL compared with patients who were unaware in a multivariate linear regression analysis (B, -0.10; 95% CI, -0.17 to -0.03, p = 0.008).
Awareness of prognosis may negatively impact survival and QoL in terminally ill cancer patients. Therefore, the patient's preference for and individual susceptibility to receiving such information should be assessed carefully before disclosure.
采用适当科学设计，研究预后信息披露对患者心理或身体状况影响的临床研究较为少见。我们在姑息治疗环境中调查了患者知晓终末期状态对生存和生活质量（QoL）的影响。
这是一项针对晚期癌症患者的前瞻性队列研究。连续纳入姑息治疗病房的癌症患者。通过半结构化访谈确定患者对其终末期状态的知晓情况。调查社会人口统计学和临床特征，包括东部肿瘤协作组体能状态、抑郁情绪和生活质量。分别采用多变量Cox比例风险回归和多变量线性回归来确定疾病知晓对生存和生活质量的独立影响。
在分析的262例病例中，中位生存时间（四分位间距）为28.5（15.8 - 55.3）天，76例（29.0%）患者不知晓自己的预后。在调整包括身体状况和抑郁等临床变量后，知晓预后的患者生存期短于不知晓的患者（风险比，1.44；95%置信区间，1.07 - 1.93，p = 0.015）。此外，在多变量线性回归分析中，与不知晓的患者相比，知晓预后的患者报告的主观生活质量较低（B， - 0.10；95%置信区间， -
