Tang Siew Tzuh, Liu Tsang-Wu, Liu Li Ni, Chiu Chang-Fang, Hsieh Ruey-Kuen, Tsai Chun-Ming
School of Nursing, Chang Gung University, Tao-Yuan, Taiwan
National Institute of Cancer Research, National Health Research Institutes, Taipei, Taiwan.
Palliat Med. 2014 Dec;28(10):1222-30. doi: 10.1177/0269216314540974. Epub 2014 Jun 25.
Honoring patients' treatment preferences is a key component of high-quality end-of-life care. Connecting clinical practices to patients' preferences requires effective communication. However, few cancer patients reported discussing end-of-life-care preferences with their physicians.
To identify correlates of physician-patient end-of-life-care discussions and to investigate associations of physician-patient end-of-life-care discussions with patient end-of-life-care preferences.
A cross-sectional survey from April 2011 through November 2012.
SETTING/PARTICIPANTS: A convenience sample of 2467 cancer patients (89.3% participation rate) whose disease was diagnosed as terminal and unresponsive to current curative cancer treatment was recruited from 23 teaching hospitals throughout Taiwan.
Only 7.8% of respondents reported discussing end-of-life-care preferences with their physicians. Physicians were more likely to discuss end-of-life-care preferences with cancer patients who accurately understood their prognosis but less likely to do so if patients were married or received care in a hospital with an inpatient hospice unit. Furthermore, physician-patient end-of-life-care discussions were significantly, positively associated with the likelihood of preferring comfort-oriented care and hospice care, but negatively associated with preferences for receiving cardiopulmonary resuscitation when life is in danger and aggressive life-sustaining treatments at end of life, including intensive care unit admission, cardiac massage, intubation, and mechanical ventilation support.
Physician-patient end-of-life-care discussions are correlated with accurate prognostic awareness, marital status, and institutional characteristics and negatively associated with terminally ill cancer patients' preferences for aggressive end-of-life care. Interventions should be developed to facilitate timely end-of-life-care discussions between at-risk patients and their physicians, thus honoring patients' end-of-life-care preferences and possibly avoiding futile life-sustaining treatments.
尊重患者的治疗偏好是高质量临终关怀的关键组成部分。将临床实践与患者偏好联系起来需要有效的沟通。然而，很少有癌症患者报告与医生讨论过临终关怀偏好。
确定医患临终关怀讨论的相关因素，并调查医患临终关怀讨论与患者临终关怀偏好之间的关联。
2011年4月至2012年11月的横断面调查。
设置/参与者：从台湾23家教学医院招募了2467名癌症患者的便利样本（参与率89.3%），其疾病被诊断为晚期且对当前的癌症治愈性治疗无反应。
只有7.8%的受访者报告与医生讨论过临终关怀偏好。医生更有可能与准确了解自身预后的癌症患者讨论临终关怀偏好，但如果患者已婚或在设有住院临终关怀病房的医院接受治疗，则医生进行此类讨论的可能性较小。此外，医患临终关怀讨论与倾向于舒适护理和临终关怀的可能性显著正相关，但与在生命危险时接受心肺复苏以及在生命末期接受积极维持生命治疗（包括入住重症监护病房、心脏按摩、插管和机械通气支持）的偏好负相关。
医患临终关怀讨论与准确的预后认知、婚姻状况和机构特征相关，并且与晚期癌症患者对积极临终关怀的偏好负相关。应制定干预措施，以促进高危患者与其医生之间及时进行临终关怀讨论，从而尊重患者的临终关怀偏好，并可能避免无效的维持生命治疗。
