Department of International Business, Soochow University, Taipei, Taiwan, R.O.C.
Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, R.O.C; Chang Gung University College of Medicine, Tao-Yuan, Taiwan, R.O.C.
J Pain Symptom Manage. 2019 Feb;57(2):190-198.e2. doi: 10.1016/j.jpainsymman.2018.11.008. Epub 2018 Nov 15.
High-quality end-of-life (EOL) care depends on thoroughly assessing terminally ill patients' preferences for EOL care and tailoring care to individual needs. Studies on predictors of EOL-care preferences were primarily cross-sectional and assessed preferences for multiple life-sustaining treatments (LSTs), making clinical applications difficult.
OBJECTIVE/METHODS: We examined factors predisposing cancer patients (N = 303) to specific LST-preference states (life-sustaining preferring, comfort preferring, uncertain, and nutrition preferring) derived from six LSTs (cardiopulmonary resuscitation, intensive care unit care, chest compression, intubation with mechanical ventilation, intravenous nutrition, and tube feeding) in patients' last six months by multilevel multinomial logistic regression.
Participants with accurate prognostic awareness and physician-patient EOL-care discussions were less likely to be in life-sustaining-preferring, uncertain, and nutrition-preferring states than in the comfort-preferring state. Better quality of life (QOL) and more depressive symptoms predisposed participants to be less likely to be in the uncertain than in the comfort-preferring state. Membership in the nutrition-preferring rather than the comfort-preferring state was significantly higher for participants in the state of moderate symptom distress with severe functional impairment than in the state of mild symptom distress with high functioning.
Accurate prognostic awareness, physician-patient EOL-care discussions, QOL, depressive symptoms, and symptom-functional states predisposed terminally ill cancer patients to distinct LST-preference states. Clinicians should cultivate patients' accurate prognostic awareness and facilitate EOL-care discussions to foster realistic expectations of LST efficacy at EOL. Clinicians should enhance patients' QOL to reduce uncertainty in EOL-care decision making and provide adequate psychological support to those with more depressive symptoms who prefer comfort care only.
高质量的临终关怀（EOL）取决于彻底评估终末期患者对 EOL 护理的偏好，并根据个人需求调整护理。关于 EOL 护理偏好预测因素的研究主要是横断面研究，并评估了对多种生命维持治疗（LST）的偏好，这使得临床应用变得困难。
目的/方法：我们通过多级多项逻辑回归，检查了导致癌症患者（N=303）进入六种 LST（心肺复苏、重症监护病房护理、胸部按压、机械通气插管、静脉营养和管饲）最后六个月特定 LST 偏好状态（维持生命偏好、舒适偏好、不确定、营养偏好）的因素（n=303）。
具有准确预后意识和医患 EOL 护理讨论的参与者不太可能处于维持生命偏好、不确定和营养偏好状态，而更可能处于舒适偏好状态。更好的生活质量（QOL）和更多的抑郁症状使参与者不太可能处于不确定状态，而更可能处于舒适偏好状态。在中度症状困扰和严重功能障碍状态下，与轻度症状困扰和高功能状态相比，处于营养偏好状态而不是舒适偏好状态的参与者比例显著更高。
准确的预后意识、医患 EOL 护理讨论、QOL、抑郁症状和症状功能状态使终末期癌症患者倾向于不同的 LST 偏好状态。临床医生应培养患者的准确预后意识，促进 EOL 护理讨论，以促进对 LST 疗效的现实期望。临床医生应提高患者的生活质量，以减少 EOL 护理决策中的不确定性，并为那些仅偏好舒适护理且抑郁症状更严重的患者提供充分的心理支持。
