Yale School of Nursing, West Haven, Connecticut, USA.
Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
J Pain Symptom Manage. 2018 Mar;55(3):890-896. doi: 10.1016/j.jpainsymman.2017.09.024. Epub 2017 Oct 10.
Although recommendations are for goals of care (GoC) conversations to happen early and often, their timing and content over the disease course remain unclear.
To describe perceptions of the timing and content of GoC conversations among oncologists and patients with advanced cancer.
Semi-structured interviews with oncologists and patients at four hospitals in New York and Connecticut. We analyzed data using interpretive description.
Oncologists (n = 21) were 67% male, averaged 46 years old (range 34-68 years), and had a mean 20 years (range 8-42 years) in practice. Advanced cancer patients (n = 39) were 59% female with a mean age of 58 years (range 26-88 years). Oncologists and patients viewed GoC conversations along an initial, intermediate, and final continuum. Oncologists reported having initial GoC conversations to build rapport, provide disease information, and clarify and consider treatment intent and options. Intermediate conversations focused on changes in treatment and side effects. Final conversations occurred when patients were hospice-eligible and covered the shift to comfort care, a treatment summary, and advance directives. Timing and content were influenced by cancer type, disease status, and emotional state. Patients supported beginning GoC conversations early, but had different preferences for content of initial conversations. Some wanted complete information; others found this overwhelming. Patients felt intermediate GoC conversations should occur at decision points with time for processing. Content of intermediate and final conversations was dependent on patients' prognosis, questions, and treatment decisions.
Although GoC conversations should follow individual patient preferences, our findings offer structure for their timing and content.
尽管人们建议目标治疗（GoC）对话应尽早且经常进行，但它们在疾病过程中的时间和内容仍不清楚。
描述肿瘤科医生和晚期癌症患者对 GoC 对话的时间和内容的看法。
在纽约和康涅狄格州的四家医院对肿瘤科医生和患者进行半结构化访谈。我们使用解释性描述对数据进行分析。
肿瘤科医生（n=21）中 67%为男性，平均年龄为 46 岁（范围 34-68 岁），平均从业时间为 20 年（范围 8-42 年）。晚期癌症患者（n=39）中 59%为女性，平均年龄为 58 岁（范围 26-88 岁）。肿瘤科医生和患者将 GoC 对话视为一个初始、中间和最终的连续体。肿瘤科医生报告说，进行初始 GoC 对话是为了建立融洽关系、提供疾病信息以及澄清和考虑治疗意图和方案。中间对话侧重于治疗变化和副作用。当患者符合临终关怀条件时，会进行最终对话，内容包括向舒适护理的转变、治疗总结和预先指示。时间和内容受癌症类型、疾病状况和情绪状态的影响。患者支持尽早开始 GoC 对话，但对初始对话的内容有不同的偏好。一些人希望获得完整的信息；另一些人则觉得这令人难以承受。患者认为中间 GoC 对话应在决策点进行，并有时间进行处理。中间和最终对话的内容取决于患者的预后、问题和治疗决策。
尽管 GoC 对话应遵循患者的个人偏好，但我们的研究结果为其时间和内容提供了结构。
