对晚期癌症的理解及其与临终关怀问题态度的关系。

The Understanding of Terminal Cancer and Its Relationship with Attitudes toward End-of-Life Care Issues.

作者信息

Lee June Koo, Yun Young Ho, An Ah Reum, Heo Dae Seog, Park Byeong-Woo, Cho Chi-Heum, Kim Sung, Lee Dae Ho, Lee Soon Nam, Lee Eun Sook, Kang Jung Hun, Kim Si-Young, Lee Jung Lim, Lee Chang Geol, Lim Yeun Keun, Kim Samyong, Choi Jong Soo, Jeong Hyun Sik, Chun Mison

机构信息

Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea (JKL, DSH)

Department of Medical Science, Seoul National University College of Medicine, Seoul, Korea (YHY)

出版信息

Med Decis Making. 2014 Aug;34(6):720-30. doi: 10.1177/0272989X13501883. Epub 2013 Aug 23.

DOI:10.1177/0272989X13501883

PMID:23975503

Abstract

BACKGROUND

Although terminal cancer is a widely used term, its meaning varies, which may lead to different attitudes toward end-of-life issues. The study was conducted to investigate differences in the understanding of terminal cancer and determine the relationship between this understanding and attitudes toward end-of-life issues.

METHODS

A questionnaire survey was performed between 2008 and 2009. A total of 1242 cancer patients, 1289 family caregivers, 303 oncologists from 17 hospitals, and 1006 participants from the general population responded.

RESULTS

A "6-month life expectancy" was the most common understanding of terminal cancer (45.6%), followed by "treatment refractoriness" (21.1%), "metastatic/recurrent disease" (19.4%), "survival of a few days/weeks" (11.4%), and "locally advanced disease" (2.5%). The combined proportion of "treatment refractoriness" and "6-month life expectancy" differed significantly between oncologists and the other groups combined (76.0% v. 65.9%, P = 0.0003). Multivariate analyses showed that patients and caregivers who understood terminal cancer as "survival of a few days/weeks" showed more negative attitudes toward disclosure of terminal status compared with participants who chose "treatment refractoriness" (adjusted odds ratio [aOR] 0.42, 95% confidence interval [CI] 0.22-0.79 for patients; aOR 0.34, 95% CI 0.18-0.63 for caregivers). Caregivers who understood terminal cancer as "locally advanced" or "metastatic/recurrent disease" showed a significantly lower percentage of agreement with withdrawal of futile life-sustaining treatment compared with those who chose "treatment refractoriness" (aOR 0.19, 95% CI 0.07-0.54 for locally advanced; aOR 0.39, 95% CI 0.21-0.72 for metastatic/recurrent).

CONCLUSIONS

The understanding of terminal cancer varied among the 4 participant groups. It was associated with different preferences regarding end-of-life issues. Standardization of these terms is needed to better understand end-of-life care.

摘要

背景

尽管“晚期癌症”是一个广泛使用的术语，但其含义各不相同，这可能导致对临终问题产生不同的态度。本研究旨在调查对晚期癌症理解的差异，并确定这种理解与对临终问题态度之间的关系。

方法

在2008年至2009年期间进行了问卷调查。共有1242名癌症患者、1289名家庭护理人员、来自17家医院的303名肿瘤学家以及1006名普通人群参与者做出了回应。

结果

“预期寿命6个月”是对晚期癌症最常见的理解（45.6%），其次是“治疗无效”（21.1%）、“转移性/复发性疾病”（19.4%）、“存活几天/几周”（11.4%）以及“局部晚期疾病”（2.5%）。肿瘤学家与其他组合并后的“治疗无效”和“预期寿命6个月”的合并比例存在显著差异（76.0%对65.9%，P = 0.0003）。多变量分析表明，与选择“治疗无效”的参与者相比，将晚期癌症理解为“存活几天/几周”的患者和护理人员对披露晚期状态表现出更消极的态度（患者的调整优势比[aOR]为0.42，95%置信区间[CI]为0.22 - 0.79；护理人员的aOR为0.34，95% CI为0.18 - 0.63）。与选择“治疗无效”的护理人员相比，将晚期癌症理解为“局部晚期”或“转移性/复发性疾病”的护理人员对放弃无效的维持生命治疗的同意率显著较低（局部晚期的aOR为0.19，95% CI为0.07 - 0.54；转移性/复发性的aOR为0.39，95% CI为0.21 - 0.72）。