RN Case Comprehensive Cancer Center, Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44104, USA.
Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44014, USA.
Support Care Cancer. 2020 Nov;28(11):5139-5146. doi: 10.1007/s00520-020-05352-w. Epub 2020 Feb 14.
The ability of oncologists to understand patients' goals of care is recognized as a key component of quality care. The purpose of this study is to examine the influence of patient-oncologist agreement regarding goals of care upon aggressive care at end of life (EOL) for patients with advanced cancer.
Patients with advanced cancer and their oncologists were interviewed at study enrollment and every 3 months thereafter until patient death or end of the study period (15 months). A 100-point visual analogue scale was used to represent goals of care, with quality of life (scored as 0) and survival (scored as 100) as anchors. Strong goal of care agreement for survival was defined as oncologist and patient dyadic goal of care scores that fell between 70 and 100 (100 = highest goal for survival) and for comfort, dyadic goal of care values that fell between 0 and 30 (0 = high goal for comfort).
Two hundred and six patients and eleven oncologists provided data. At the last interview prior to death, 23.3% of dyads had strong goal of care agreement for either survival (8.3%) or comfort (15%) and 76.7% had no strong agreement. There was a significant association between aggressive care use and categories of dyadic agreement regarding goals of care (p = 0.024, Cramer's V = 0.15).
A large percentage of oncologists did not understand their patients' EOL goals of care. While aggressive care aligned with categories of dyadic agreement for goals of care, high rates of aggressive care were reported.
肿瘤学家理解患者的治疗目标被认为是高质量医疗的关键组成部分。本研究旨在探讨患者与肿瘤医生在治疗目标上的一致性对晚期癌症患者生命末期（EOL）积极治疗的影响。
在研究入组时和此后每 3 个月，对患有晚期癌症的患者及其肿瘤医生进行访谈，直至患者死亡或研究期（15 个月）结束。使用 100 点视觉模拟量表来表示治疗目标，以生活质量（得分为 0）和生存（得分为 100）为参考点。生存目标的强烈一致性定义为肿瘤医生和患者的目标治疗评分在 70 到 100 之间（100=最高生存目标），而舒适度的强烈一致性定义为目标治疗评分在 0 到 30 之间（0=最高舒适度目标）。
206 名患者和 11 名肿瘤医生提供了数据。在死亡前的最后一次访谈中，23.3%的患者和医生对生存（8.3%）或舒适度（15%）有强烈的治疗目标一致性，76.7%的患者和医生没有强烈的一致性。积极治疗的使用与治疗目标的患者-医生一致性类别之间存在显著关联（p=0.024，Cramer's V=0.15）。
很大比例的肿瘤医生并不了解患者的 EOL 治疗目标。尽管积极的治疗与治疗目标的患者-医生一致性类别一致，但报告的积极治疗率仍然很高。
