对初级保健中临终癌症患者难以忍受的痛苦和安乐死请求进行前瞻性研究。
Unbearable suffering and requests for euthanasia prospectively studied in end-of-life cancer patients in primary care.
作者信息
Ruijs Cees Dm, van der Wal Gerrit, Kerkhof Ad Jfm, Onwuteaka-Philipsen Bregje D
机构信息
Department of Public and Occupational Health, VU University Medical Center, EMGO+ Institute, Expertise Center for Palliative Care, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands ; Primary Care Center De Greev, Grevelingenstraat 10, 3522 PR Utrecht, The Netherlands.
Department of Public and Occupational Health, VU University Medical Center, EMGO+ Institute, Expertise Center for Palliative Care, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
出版信息
BMC Palliat Care. 2014 Dec 23;13(1):62. doi: 10.1186/1472-684X-13-62. eCollection 2014.
BACKGROUND
An international discussion about whether or not to legally permit euthanasia and (or) physician assisted suicide (EAS) is ongoing. Unbearable suffering in patients may result in a request for EAS. In the Netherlands EAS is legally permitted, and unbearable suffering is one of the central compulsory criteria. The majority of EAS is performed in cancer patients in the primary care practice. In around one in every seven end-of-life cancer patients dying in the primary care setting EAS is performed. The prevalence of unbearable symptoms and overall unbearable suffering in relationship to explicit requests for EAS was studied in a cohort of end-of-life cancer patients in primary care.
METHODS
A prospective study in primary care cancer patients estimated to die within six months was performed. Every two months suffering was assessed with the State-of-Suffering V (SOS-V). The SOS-V is a comprehensive instrument for quantitative and qualitative assessment of unbearable suffering related to 69 physical, psychological and social symptoms in five domains.
RESULTS
Out of 148 patients who were asked to participate 76 (51%) entered the study. The studied population were 64 patients who were followed up until death; 27% explicitly requested EAS, which was performed in 8% of the patients. The final interview per patient was analyzed; in four patients the SOS-V was missing. Unbearable symptoms were present in 94% of patients with an explicit request for EAS and in 87% of patients without an explicit request. No differences were found in the prevalence of unbearable suffering for physical, psychological, social and existential symptoms, nor for overall unbearable suffering, between patients who did or who did not explicitly request EAS.
CONCLUSIONS
In a population of end-of-life cancer patients cared for in primary care no differences in unbearable suffering were found between patients with and without explicit requests for EAS. The study raises the question whether unbearable suffering is the dominant motive to request for EAS. Most patients suffered from unbearable symptoms, indicating that the compulsory criterion of unbearable suffering may be met a priori in most end-of-life cancer patients dying at home, whether they request EAS or not.
背景
关于是否应合法允许安乐死和（或）医生协助自杀（EAS）的国际讨论正在进行。患者难以忍受的痛苦可能导致其提出EAS请求。在荷兰，EAS在法律上是被允许的，难以忍受的痛苦是核心强制标准之一。大多数EAS是在初级医疗实践中的癌症患者中实施的。在初级医疗环境中死亡的临终癌症患者中，约每七人中有一人接受了EAS。本研究在一组初级医疗中的临终癌症患者中，探讨了与明确的EAS请求相关的难以忍受症状的发生率以及总体难以忍受的痛苦情况。
方法
对预计在六个月内死亡的初级医疗癌症患者进行了一项前瞻性研究。每两个月用痛苦状态量表V（SOS-V）评估一次痛苦程度。SOS-V是一种综合工具，用于对与五个领域中69种身体、心理和社会症状相关的难以忍受的痛苦进行定量和定性评估。
结果
在被邀请参与的148名患者中，76名（51%）进入了研究。研究人群为64名随访至死亡的患者；27%的患者明确请求EAS，其中8%的患者接受了EAS。对每位患者的最后一次访谈进行了分析；四名患者的SOS-V缺失。明确请求EAS的患者中有94%存在难以忍受的症状，未明确请求EAS的患者中有87%存在难以忍受的症状。在明确请求EAS和未明确请求EAS的患者之间，身体、心理、社会和存在症状的难以忍受痛苦发生率以及总体难以忍受的痛苦方面均未发现差异。
结论
在接受初级医疗护理的临终癌症患者群体中，明确请求EAS和未明确请求EAS的患者在难以忍受的痛苦方面没有差异。该研究提出了一个问题，即难以忍受的痛苦是否是请求EAS的主要动机。大多数患者都遭受着难以忍受的症状，这表明对于大多数在家中死亡的临终癌症患者来说，无论他们是否请求EAS，难以忍受的痛苦这一强制标准可能在事前就已满足。
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