Liu Li N, Chen Chen H, Liu Tsang W, Lin Yu C, Lee Shiuyu C K, Tang Siew T
Author Affiliations: Department of Nursing, Fu Jen Catholic University, New Taipei City, Taiwan (Dr Liu); Department of Nursing, Kang-Ning Junior College of Medical Care and Management, and School of Nursing, Chang Gung University, Tao-Yuan, Taiwan (Ms Chen); National Institute of Cancer Research, National Health Research Institutes, Taipei, Taiwan (Dr Liu); Department of Nursing, Tzu Chi University, Hualien, Taiwan (Dr Lin); Department of Nursing, National Taipei University of Nursing and Health Science, Taiwan (Dr Lee); School of Nursing, Medical College, Chang Gung University, Tao-Yuan, Taiwan (Dr Tang).
Cancer Nurs. 2015 May-Jun;38(3):E9-E18. doi: 10.1097/NCC.0000000000000155.
Studies on factors influencing preferences for aggressive end-of-life (EOL) care have focused predominantly on preferred goals of EOL and seldom comprehensively incorporate patients' predisposing, enabling, and need factors into their analyses.
The aim of this study was to investigate the determinants of preferences for a wide range of aggressive EOL care from the aforementioned factors.
A cross-sectional survey was conducted using a convenience sample of 2329 terminally ill cancer patients recruited from 23 hospitals throughout Taiwan.
Among these Taiwanese terminally ill cancer patients, 8.2% preferred prolonging life as their goal for EOL care. When combining those who wanted and those who were undecided as wanting that specific treatment, 27.9% preferred cardiopulmonary resuscitation when their life was in danger, and 36.0%, 27.3%, 24.3%, and 26.7% preferred to receive care at intensive care unit, cardiac massage, intubation, and mechanical ventilation support, respectively. Those at risk of preferring aggressive EOL care were men, younger than 45 years, married, diagnosed within 6 months, and with comorbidity and their physician had not accurately disclosed their prognosis or discussed EOL care issues to/with them.
Few Taiwanese terminally ill cancer patients preferred to prolong life as their goal for EOL care, cardiopulmonary resuscitation when their life was in danger, and life-sustaining treatments at EOL. Preferences for aggressive EOL care are determined by patients' predisposing, enabling, and need factors.
Terminally ill cancer patients at risk of preferring aggressive EOL care should receive interventions to help them appropriately weigh the burdens and benefits of such aggressive treatments.
关于影响积极临终关怀偏好因素的研究主要集中在临终关怀的首选目标上，很少将患者的易患因素、促成因素和需求因素全面纳入分析。
本研究旨在从上述因素调查广泛的积极临终关怀偏好的决定因素。
采用横断面调查，对从台湾23家医院招募的2329名晚期癌症患者进行便利抽样。
在这些台湾晚期癌症患者中，8.2%的人倾向将延长生命作为临终关怀的目标。当把希望和未决定是否希望接受特定治疗的人合并计算时，27.9%的人在生命垂危时倾向于接受心肺复苏，36.0%、27.3%、24.3%和26.7%的人分别倾向于在重症监护病房接受治疗、接受心脏按摩、插管和机械通气支持。倾向于积极临终关怀的风险人群为男性、年龄小于45岁、已婚、确诊时间在6个月内、患有合并症且医生未准确告知其预后或未与其讨论临终关怀问题的患者。
很少有台湾晚期癌症患者倾向将延长生命作为临终关怀的目标、在生命垂危时接受心肺复苏以及在临终时接受维持生命的治疗。积极临终关怀的偏好由患者的易患因素、促成因素和需求因素决定。
有倾向于积极临终关怀风险的晚期癌症患者应接受干预措施，以帮助他们适当权衡此类积极治疗的负担和益处。
