癌症终末期患者对生命维持治疗偏好的十年变化。
A Decade of Changes in Preferences for Life-Sustaining Treatments Among Terminally Ill Patients With Cancer.
机构信息
From Chang Gung University, School of Nursing, Taipei, Taiwan; National Institute of Cancer Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan; Department of International Business, Soochow University, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Division of Hematology-Oncology, Department of Internal Medicine, Taipei City Hospital, Ren'ai Branch, Taipei, Taiwan; Division of Hemato-Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Changhua County, Tawian; Division of Hematology-Oncology Department of Medicine, Cathay General Hospital, Taipei, Taiwan; Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Hemato-oncology, Taipei Tzu Chi General Hospital, Taipei, Taiwan; Department of Nursing, Fu Jen Catholic University, Taipei, Taiwan; and Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan.
出版信息
J Natl Compr Canc Netw. 2015 Dec;13(12):1510-8. doi: 10.6004/jnccn.2015.0179.
BACKGROUND
Changes over time in preferences for life-sustaining treatments (LSTs) at end of life (EOL) in different patient cohorts are not well established, nor is the concept that LST preferences represent more than 2 groups (uniformly prefer/not prefer).
PURPOSE
The purpose of this study was to explore heterogeneity and changes in patterns of LST preferences among 2 independent cohorts of terminally ill patients with cancer recruited a decade apart.
METHODS
Preferences for cardiopulmonary resuscitation, intensive care unit care, cardiac massage, intubation with mechanical ventilation, intravenous nutritional support, nasogastric tube feeding, and dialysis were surveyed among 2,187 and 2,166 patients in 2003-2004 and 2011-2012, respectively. Patterns and changes in LST preferences were examined by multigroup latent class analysis.
RESULTS
We identified 7 preference classes: uniformly preferring, uniformly rejecting, uniformly uncertain, favoring nutritional support but rejecting other treatments, favoring nutritional support but uncertain about other treatments, favoring intravenous nutritional support with mixed rejection of or uncertainty about other treatments, and preferring LSTs except intubation with mechanical ventilation. Probability of class membership decreased significantly over time for the uniformly preferring class (15.26%-8.71%); remained largely unchanged for the classes of uniformly rejecting (41.71%-40.54%) and uniformly uncertain (9.10%-10.47%), and favoring nutritional support but rejecting (20.68%-21.91%) or uncertain about (7.02%-5.47%) other treatments, and increased significantly for the other 2 classes. The LST preferences of Taiwanese terminally ill patients with cancer are not a homogeneous construct and shifted toward less-aggressive treatments over the past decade.
CONCLUSIONS
Identifying LST preference patterns and tailoring interventions to the unique needs of patients in each LST preference class may lead to the provision of less-aggressive EOL care.
背景
不同患者群体在生命末期（EOL）对维持生命治疗（LST）的偏好随时间的变化尚不清楚，也不清楚 LST 偏好不仅仅代表 2 个群体（一致偏好/不偏好）的概念。
目的
本研究旨在探讨 20 年前和 10 年后招募的 2 组独立的晚期癌症患者的 LST 偏好模式的异质性和变化。
方法
分别在 2003-2004 年和 2011-2012 年调查了 2187 名和 2166 名患者对心肺复苏、重症监护病房治疗、心脏按摩、插管机械通气、静脉营养支持、鼻胃管喂养和透析的偏好。通过多组潜在类别分析检查 LST 偏好模式和变化。
结果
我们确定了 7 种偏好类别：一致偏好、一致反对、一致不确定、支持营养支持但反对其他治疗、支持营养支持但对其他治疗不确定、支持静脉营养支持但对其他治疗混合反对或不确定、除了机械通气插管外还优先选择 LST。随时间推移，一致偏好类别的成员概率显著下降（15.26%-8.71%）；一致反对（41.71%-40.54%）和一致不确定（9.10%-10.47%）类别的成员概率基本不变，支持营养支持但反对（20.68%-21.91%）或对其他治疗不确定（7.02%-5.47%），其他 2 类的成员概率显著增加。过去十年，台湾晚期癌症患者的 LST 偏好不是一个同质的结构，并且向治疗不太积极的方向转变。
结论
确定 LST 偏好模式，并根据每个 LST 偏好类别患者的独特需求调整干预措施，可能会导致提供不太积极的 EOL 护理。
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