1 Division of Palliative Medicine, Department of Family Medicine, University of Vermont Medical Center , Burlington, Vermont.
2 School of Nursing, University of Rochester , Rochester, New York.
J Palliat Med. 2018 Mar;21(3):315-321. doi: 10.1089/jpm.2017.0285. Epub 2017 Sep 18.
Prognostic uncertainty is common in advanced cancer and frequently addressed during palliative care consultation, yet we know little about its impact on quality of life (QOL).
We describe the prevalence and distribution of distress due to prognostic uncertainty among hospitalized patients with advanced cancer before palliative care consultation. We evaluate the association between this type of distress and overall QOL before and after palliative care consultation.
Observational cohort study.
SETTING & PARTICIPANTS: Hospitalized patients with advanced cancer who receive a palliative care consultation at two geographically distant academic medical centers.
At the time of enrollment, before palliative care consultation, we asked participants: "Over the past two days, how much have you been bothered by uncertainty about what to expect from the course of your illness?" (Not at all/Slightly/Moderately/Quite a Bit/Extremely). We defined responses of "Quite a bit" and "Extremely" to be indicative of substantial distress.
Two hundred thirty-six participants completed the baseline assessment. Seventy-seven percent reported being at least moderately bothered by prognostic uncertainty and half reported substantial distress. Compared with others, those who were distressed by prognostic uncertainty (118/236) reported poorer overall QOL before palliative care consultation (mean QOL 3.8 out of 10 vs. 5.3 out of 10, p = < 0.001) and greater improvement in QOL following consultation (Adjusted difference in mean QOL change = 1.1; 95% confidence interval = 0.2, 2.0).
Prognostic uncertainty is a prevalent source of distress among hospitalized patients with advanced cancer at the time of initial palliative care consultation. Distress from prognostic uncertainty is associated with lower levels of preconsultation QOL and with greater pre-post consultation improvement in the QOL.
在晚期癌症中，预后不确定性很常见，并且经常在姑息治疗咨询中得到解决，但我们对其对生活质量（QOL）的影响知之甚少。
我们描述了在接受姑息治疗咨询之前，住院的晚期癌症患者中因预后不确定性而导致的困扰的发生率和分布情况。我们评估了这种类型的困扰与姑息治疗咨询前后整体 QOL 之间的关系。
观察性队列研究。
在两个地理位置不同的学术医疗中心接受姑息治疗咨询的住院晚期癌症患者。
在登记时，即姑息治疗咨询之前，我们询问参与者：“在过去两天中，您对疾病过程的预期有多少不确定性感到困扰？”（根本不/有点/中度/相当多/非常多）。我们将“相当多”和“非常多”的回答定义为表示存在大量困扰。
236 名参与者完成了基线评估。77％的人报告说至少受到中度困扰，而一半的人报告说存在大量困扰。与其他人相比，那些因预后不确定性而感到困扰的人（236 人中的 118 人）在接受姑息治疗咨询之前的整体 QOL 较差（平均 QOL 为 10 分中的 3.8 分，而 10 分中的 5.3 分，p<0.001），并且咨询后 QOL 的改善更大（调整后的平均 QOL 变化差异为 1.1；95％置信区间为 0.2，2.0）。
在接受姑息治疗咨询时，住院的晚期癌症患者中，预后不确定性是一种普遍存在的困扰源。对预后不确定性的困扰与咨询前 QOL 水平较低以及咨询前后 QOL 的改善更大有关。
