An Ah Reum, Lee June-Koo, Yun Young Ho, Heo Dae Seog
Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Palliat Med. 2014 Jul;28(7):976-985. doi: 10.1177/0269216314531312. Epub 2014 Apr 29.
Previous studies on hospice/palliative care indicated that patients' socio-demographic factors, disease status, and availability of health-care resources were associated with hospice/palliative care utilization. However, the impact of family caregivers on hospice/palliative care utilization has not been thoroughly investigated.
To evaluate the association between attitudes toward hospice/palliative care of both patients with terminal cancer (defined as progressive, advanced cancer in which the patient will die within months) and their family caregivers and utilization of inpatient hospice/palliative care facilities.
A prospective observational cohort study was performed in 12 hospitals in South Korea. Attitude toward hospice/palliative care was assessed immediately after terminal cancer diagnosis. After the patient's death, caregivers were interviewed whether they utilized hospice/palliative care facilities.
A total of 359 patient-caregiver dyads completed baseline questionnaires. After the patients' death, 257 caregivers were interviewed.
At the baseline questionnaire, 137/359 (38.2%) patients and 185/359 (51.5%) of caregivers preferred hospice/palliative care. Preference for hospice/palliative care was associated with awareness of terminal status among both patients (adjusted odds ratio: 1.87, 95% confidence interval: 1.16-3.03) and caregivers (adjusted odds ratio: 2.14, 95% confidence interval: 1.20-3.81). Religion, metastasis, and poor performance status were also independently associated with patient preference for hospice/palliative care. At the post-bereavement interview, 104/257 (40.5%) caregivers responded that they utilized hospice/palliative care facilities. Caregiver's preferences for hospice/palliative care were significantly associated with actual utilization (adjusted odds ratio: 2.67, 95% confidence interval: 1.53-4.67). No patient-related factors were associated with hospice/palliative care utilization.
Promoting awareness of prognosis and to improve communication between doctors and families is important for facilitating the use of hospice/palliative care.
先前关于临终关怀/姑息治疗的研究表明，患者的社会人口学因素、疾病状况以及医疗资源的可及性与临终关怀/姑息治疗的利用相关。然而，家庭照护者对临终关怀/姑息治疗利用的影响尚未得到充分研究。
评估晚期癌症患者（定义为病情进展、处于晚期且患者将在数月内死亡的癌症）及其家庭照护者对临终关怀/姑息治疗的态度与住院临终关怀/姑息治疗设施利用之间的关联。
在韩国的12家医院进行了一项前瞻性观察队列研究。在晚期癌症诊断后立即评估对临终关怀/姑息治疗的态度。患者死亡后，对照护者进行访谈，询问他们是否使用了临终关怀/姑息治疗设施。
共有359对患者-照护者二元组完成了基线问卷。患者死亡后，对257名照护者进行了访谈。
在基线问卷中，137/359（38.2%）的患者和185/359（51.5%）的照护者倾向于临终关怀/姑息治疗。对临终关怀/姑息治疗的偏好与患者（调整后的优势比：1.87，95%置信区间：1.16 - 3.03）和照护者（调整后的优势比：2.14，95%置信区间：1.20 - 3.81）对终末期状态的认知相关。宗教信仰、转移和较差的体能状态也与患者对临终关怀/姑息治疗的偏好独立相关。在丧亲后访谈中，104/257（40.5%）的照护者表示他们使用了临终关怀/姑息治疗设施。照护者对临终关怀/姑息治疗的偏好与实际利用显著相关（调整后的优势比：2.67，95%置信区间：1.53 - 4.67）。没有患者相关因素与临终关怀/姑息治疗的利用相关。
提高对预后的认知并改善医生与家庭之间的沟通对于促进临终关怀/姑息治疗的使用很重要。
