Yotani Nobuyuki, Kizawa Yoshiyuki, Shintaku Haruo
Kobe University Graduate School of Medicine, Kobe, Japan; Osaka City University Graduate School of Medicine, Osaka, Japan.
Kobe University Graduate School of Medicine, Kobe, Japan.
J Pediatr. 2017 Mar;182:356-362. doi: 10.1016/j.jpeds.2016.11.079. Epub 2016 Dec 28.
To evaluate differences between pediatricians and internists in the practice of and barriers to advance care planning (ACP) for adolescent patients with cancer.
A self-reported questionnaire was administered to assess the practice of ACP, advance directives, and barriers to ACP for adolescent patients with cancer. All 3392 Japanese board-certified hematologists were surveyed, and 600 hematologists (227 pediatricians, 373 internists) who take care of adolescent patients with cancer with decision-making capacity were analyzed.
If a patient's prognosis for survival was <3 months, pediatricians were significantly less likely to discuss ACP with their patients than internists, including discussions regarding the patient's medical condition (59% vs 70%), the patient's understanding of his/her medical condition (55% vs 66%), do not attempt resuscitation orders (17% vs 24%), and ventilator treatment if the patient's condition worsened (19% vs 25%). More than 75% of hematologists (both pediatricians and internists) discussed all ACP topics with patients' families. Similarly, with regard to advance directives, pediatricians were less likely than internists to discuss cardiopulmonary resuscitation (24% vs 47%) and the use of ventilators (31% vs 51%), vasopressors (24% vs 42%), and antibiotics (21% vs 31%) with their patients. Both pediatricians and internists discussed these issues more often with patients' families than with patients, especially cardiopulmonary resuscitation (98%) as well as the use of ventilators (98%) and vasopressors (91%).
Pediatricians were less likely than internists to discuss ACP and advance directives with patients, and both pediatricians and internists tended to discuss ACP and advance directives more often with patients' families.
评估儿科医生和内科医生在为患有癌症的青少年患者进行预先护理计划（ACP）的实践及障碍方面的差异。
采用一份自我报告问卷来评估ACP的实践、预先指示以及患有癌症的青少年患者进行ACP的障碍。对所有3392名日本血液学专科医生进行了调查，并分析了其中600名负责照顾具有决策能力的患有癌症的青少年患者的血液学专科医生（227名儿科医生，373名内科医生）。
如果患者的生存预后小于3个月，与内科医生相比，儿科医生与患者讨论ACP的可能性显著降低，包括讨论患者的病情（59%对70%）、患者对自身病情的理解（55%对66%）、不进行心肺复苏医嘱（17%对24%）以及患者病情恶化时的呼吸机治疗（19%对25%）。超过75%的血液学专科医生（儿科医生和内科医生）与患者家属讨论了所有ACP主题。同样，关于预先指示，与内科医生相比，儿科医生与患者讨论心肺复苏（24%对47%）、呼吸机使用（31%对51%）、血管加压药（24%对42%）和抗生素（21%对31%）的可能性较小。儿科医生和内科医生与患者家属讨论这些问题的频率都高于与患者讨论的频率，尤其是心肺复苏（98%）以及呼吸机使用（98%）和血管加压药（91%）。
与内科医生相比，儿科医生与患者讨论ACP和预先指示的可能性较小，并且儿科医生和内科医生都倾向于更频繁地与患者家属讨论ACP和预先指示。
