Stout Jeremiah, Kumbamu Ashok, Tilburt Jon, Fernandez Cara, Geller Gail, Koenig Barbara, Lenz Heinz-Josep, Jatoi Aminah
6915Mayo Clinic, Rochester, MN, USA.
Berman Institute of Bioethics, Johns Hopkins Bloomberg School of Public Health, 1466Johns Hopkins University, Baltimore, MD, USA.
Am J Hosp Palliat Care. 2021 Feb;38(2):175-179. doi: 10.1177/1049909120930710. Epub 2020 Jun 4.
As many as 20% of oncology patients receive chemotherapy in the last 14 days of their lives. This study characterized conversations between patients and cancer clinicians on chemotherapy cessation in the setting of advanced cancer.
This 3-site study captured real-time, audio-recorded interviews between oncology clinicians and patients with cancer during actual clinic visits. Audio-recordings were reviewed for discussion of chemotherapy cessation and were analyzed qualitatively.
Among 525 recordings, 14 focused on stopping chemotherapy; 14 patients participated with 11 different clinicians. Two types of nonmutually exclusive conversation elements emerged: direct and specific elements that described an absence of effective therapeutic options and indirect elements. An example of a direct element is as follows: "…You know this is…always really tough…But I-I think that you may need more help…I think we're close to stopping chemotherapy…And hospice is really helpful to have in place…" In contrast, the second conversation element was more convoluted: "…transplant is not an option and surgery is not an option…The options…are taking a pill…It doesn't shrink the tumor…It may help you live a little longer. But I'm worried if [you] had the pill, it's still a therapy and it still has side effects. I [am] worried if I give it to you now, that you're so weak, it will make you worse." No relationship seemed apparent between conversation elements and chemotherapy cessation.
Conversations on chemotherapy cessation are complex; multiple factors appear to drive the decision to stop.
多达20%的肿瘤患者在生命的最后14天接受化疗。本研究描述了晚期癌症患者与癌症临床医生之间关于停止化疗的对话。
这项三中心研究在实际门诊就诊期间，对肿瘤临床医生与癌症患者之间的实时音频访谈进行了记录。对音频记录进行审查，以查找有关停止化疗的讨论，并进行定性分析。
在525份记录中，有14份聚焦于停止化疗；14名患者与11名不同的临床医生参与。出现了两种并非相互排斥的对话元素：描述缺乏有效治疗选择的直接和具体元素以及间接元素。直接元素的一个例子如下：“……你知道这一直都非常艰难……但我认为你可能需要更多帮助……我认为我们快到停止化疗的时候了……临终关怀真的很有帮助……”相比之下，第二种对话元素更为复杂：“……移植不是一个选择，手术也不是一个选择……选择是……服用一种药丸……它不会缩小肿瘤……它可能会帮助你活得更长一点。但我担心如果你服用了这种药丸，它仍然是一种治疗方法，仍然有副作用。我担心如果我现在给你服用，你这么虚弱，这会让你情况更糟。”对话元素与停止化疗之间似乎没有明显关系。
关于停止化疗的对话很复杂；多种因素似乎推动了停止化疗的决定。
