School of Social Work,The University of Texas at Arlington,Arlington,Texas.
College of Public Health and Social Justice,Saint Louis University,St. Louis,Missouri.
Palliat Support Care. 2017 Oct;15(5):554-564. doi: 10.1017/S1478951516001012. Epub 2017 Jan 18.
Our aim was to explore preparation for the end of life (EoL) and life closure among persons with advanced metastatic lung cancer. Understanding quality of life through the lens of preparation and completion is important since the trajectory of lung cancer can be relatively short, often leading to application of cancer-directed therapies near death without the opportunity for advance planning or palliative care. Clinical research is needed to understand the kinds of distress specific to older adults with advanced lung cancer that are amendable to palliative care interventions.
We employed an exploratory cross-sectional design to examine psychosocial and existential concerns among a purposive sample (N = 30) of advanced lung cancer patients using the "end-of-life preparation" and "life completion" subscales of the Quality of Life at the End of Life (QUAL-E) questionnaire. Nonparametric methods were employed to analyze preparation, completion, global quality of life (QoL), and the associations among depressive symptoms, preparation, completion, and global QoL.
Higher scores on life completion were associated with better global QoL, and with items related to transcendence, communicative acts, and interpersonal relationships demonstrating important contributions. The perception of being a future burden on family members was the greatest concern within the preparation domain. Depressive symptoms were not associated with preparation, completion, or global QoL.
Psychosocial and existential issues contribute to QoL at the EoL among older adults with late-stage lung cancer during cancer-directed therapy, concurrent care, and hospice. The role of preparation, especially self-perceived burden, merits further research early on in the oncological setting. The preparation and life completion subscales of the QUAL-E are feasible clinical tools for facilitating dyadic communication about sensitive topics in the palliative care setting.
本研究旨在探讨晚期转移性肺癌患者的临终准备和生命终结。通过准备和完成的视角来理解生活质量很重要，因为肺癌的病程通常较短，往往导致在接近死亡时应用癌症定向治疗，而没有机会进行预先计划或姑息治疗。需要进行临床研究来了解晚期肺癌老年患者特有的易受姑息治疗干预影响的各种困扰。
我们采用探索性横截面设计，使用生活质量在生命终末期问卷（QUAL-E）的“临终准备”和“生命完成”分量表，对晚期肺癌患者的心理社会和存在问题进行了定量研究。采用非参数方法分析了准备、完成、整体生活质量（QoL）以及抑郁症状、准备、完成和整体 QoL 之间的关联。
更高的生命完成得分与更好的整体 QoL 相关，与超越、沟通行为和人际关系相关的项目表现出重要贡献。在准备领域，被认为是未来家庭成员负担的看法是最大的关注点。抑郁症状与准备、完成或整体 QoL 无关。
心理社会和存在问题在癌症定向治疗、同时护理和姑息治疗期间，对晚期肺癌老年患者的临终生活质量有影响。准备的作用，特别是自我感知的负担，值得在肿瘤学环境中尽早进一步研究。QUAL-E 的准备和生命完成分量表是姑息治疗环境中促进敏感话题的双元沟通的可行临床工具。
