Case Comprehensive Cancer Center, Cleveland, OH.
Case Western Reserve University, Cleveland, OH.
Curr Oncol. 2019 Dec;26(6):370-379. doi: 10.3747/co.26.5431. Epub 2019 Dec 1.
Shared decision-making at end of life (eol) requires discussions about goals of care and prioritization of length of life compared with quality of life. The purpose of the present study was to describe patient and oncologist discordance with respect to goals of care and to explore possible predictors of discordance.
Patients with metastatic cancer and their oncologists completed an interview at study enrolment and every 3 months thereafter until the death of the patient or the end of the study period (15 months). All interviewees used a 100-point visual analog scale to represent their current goals of care, with quality of life (scored as 0) and survival (scored as 100) serving as anchors. Discordance was defined as an absolute difference between patient and oncologist goals of care of 40 points or more.
The study enrolled 378 patients and 11 oncologists. At baseline, 24% discordance was observed, and for patients who survived, discordance was 24% at their last interview. For patients who died, discordance was 28% at the last interview before death, with discordance having been 70% at enrolment. Dissatisfaction with eol care was reported by 23% of the caregivers for patients with discordance at baseline and by 8% of the caregivers for patients who had no discordance ( = 0.049; ϕ = 0.20).
The data indicate the presence of significant ongoing oncologist-patient discordance with respect to goals of care. Early use of a simple visual analog scale to assess goals of care can inform the oncologist about the patient's goals and lead to delivery of care that is aligned with patient goals.
生命末期（eol）的共同决策需要讨论医疗护理目标，并对生命长度与生活质量进行优先级排序。本研究的目的是描述患者和肿瘤医生在医疗护理目标方面的不一致，并探讨可能导致不一致的预测因素。
患有转移性癌症的患者及其肿瘤医生在研究入组时以及此后每 3 个月进行一次访谈，直至患者死亡或研究期结束（15 个月）。所有受访者均使用 100 点视觉模拟量表来表示他们当前的医疗护理目标，其中生活质量（得分为 0）和生存（得分为 100）作为参考。差异定义为患者和肿瘤医生的医疗护理目标绝对差值为 40 分或以上。
该研究共纳入 378 名患者和 11 名肿瘤医生。在基线时，观察到 24%的差异，对于存活的患者，在最后一次访谈时差异为 24%。对于死亡的患者，在死亡前的最后一次访谈中差异为 28%，在入组时差异为 70%。在基线存在差异的患者中，有 23%的护理人员对生命末期护理不满意，而无差异的患者中，有 8%的护理人员不满意（=0.049；ϕ=0.20）。
数据表明，在医疗护理目标方面，肿瘤医生和患者之间存在显著的持续不一致。早期使用简单的视觉模拟量表评估医疗护理目标，可以让肿瘤医生了解患者的目标，并提供与患者目标一致的护理。
