Kumar Pallavi, Wright Alexi A, Hatfield Laura A, Temel Jennifer S, Keating Nancy L
Pallavi Kumar, University of Pennsylvania, Philadelphia, PA; Alexi A. Wright, Laura A. Hatfield, Jennifer S. Temel, and Nancy L. Keating, Harvard Medical School, and Nancy L. Keating, Brigham and Women's Hospital, Boston, MA.
J Clin Oncol. 2017 Feb;35(4):432-439. doi: 10.1200/JCO.2016.68.9257. Epub 2016 Dec 19.
Purpose To determine whether hospice use by patients with cancer is associated with their families' perceptions of patients' symptoms, goal attainment, and quality of end-of-life (EOL) care. Methods We interviewed 2,307 families of deceased patients with advanced lung or colorectal cancer who were enrolled in the Cancer Care Outcomes Research and Surveillance study (a multiregional, prospective, observational study) and died by 2011. We used propensity-score matching to compare family-reported outcomes for patients who did and did not receive hospice care, including the presence and relief of common symptoms (ie, pain, dyspnea), concordance with patients' wishes for EOL care and place of death, and quality of EOL care. We also examined associations between hospice length of stay and these outcomes among hospice enrollees. Results In a propensity-score-matched sample of 1,970 individuals, families of patients enrolled in hospice reported more pain in their patient compared with those not enrolled in hospice. However, families of patients enrolled in hospice more often reported that patients received "just the right amount" of pain medicine (80% v 73%; adjusted difference, 7 percentage points; 95% confidence interval [CI], 1 to 12 percentage points) and help with dyspnea (78% v 70%; adjusted difference, 8 percentage points; 95% CI, 2 to 13 percentage points). Families of patients enrolled in hospice also more often reported that patients' EOL wishes were followed (80% v 74%; adjusted difference, 6 percentage points; 95% CI, 2 to 11 percentage points) and "excellent" quality EOL care (57% v 42%; adjusted difference, 15 percentage points; 95% CI, 11 to 20). Families of patients who received > 30 days of hospice care reported the highest quality EOL outcomes. Conclusion Hospice care is associated with better symptom relief, patient-goal attainment, and quality of EOL care. Encouraging earlier and increased hospice enrollment may improve EOL experiences for patients with cancer and their families.
目的 确定癌症患者使用临终关怀服务是否与其家人对患者症状、目标达成情况以及临终（EOL）护理质量的认知相关。方法 我们对2307名晚期肺癌或结直肠癌已故患者的家属进行了访谈，这些患者参加了癌症护理结局研究与监测（一项多区域、前瞻性、观察性研究），并于2011年前去世。我们使用倾向得分匹配法比较接受和未接受临终关怀服务患者的家属报告的结局，包括常见症状（即疼痛、呼吸困难）的存在与缓解情况、与患者临终护理和死亡地点意愿的一致性以及临终护理质量。我们还研究了临终关怀住院时间与临终关怀服务接受者这些结局之间的关联。结果 在1970名个体的倾向得分匹配样本中，与未接受临终关怀服务患者的家属相比，接受临终关怀服务患者的家属报告其患者疼痛更多。然而，接受临终关怀服务患者的家属更常报告患者接受了“适量”的止痛药（80%对73%；调整后差异为7个百分点；95%置信区间[CI]为1至12个百分点）以及呼吸困难得到了缓解（78%对70%；调整后差异为8个百分点；95%CI为2至13个百分点）。接受临终关怀服务患者的家属也更常报告患者的临终意愿得到了遵循（80%对74%；调整后差异为6个百分点；95%CI为2至11个百分点）以及临终护理质量为“优秀”（57%对42%；调整后差异为15个百分点；95%CI为11至20）。接受临终关怀服务超过30天患者的家属报告的临终结局质量最高。结论 临终关怀服务与更好的症状缓解、患者目标达成以及临终护理质量相关。鼓励更早及更多地接受临终关怀服务可能会改善癌症患者及其家属的临终体验。
