晚期癌症患者对治疗目标的认知与心理困扰的关系。
Relationship Between Perceptions of Treatment Goals and Psychological Distress in Patients With Advanced Cancer.
机构信息
1Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center.
2Harvard Medical School, and.
出版信息
J Natl Compr Canc Netw. 2020 Jul;18(7):849-855. doi: 10.6004/jnccn.2019.7525.
BACKGROUND
Studies have shown gaps in prognostic understanding among patients with cancer. However, few studies have explored patients' perceptions of their treatment goals versus how they perceive their oncologist's goals, and the association of these views with their psychological distress.
METHODS
We conducted a cross-sectional study of 559 patients with incurable lung, gastrointestinal, breast, and brain cancers. The Prognosis and Treatment Perception Questionnaire was used to assess patients' reports of their treatment goal and their oncologist's treatment goal, and the Hospital Anxiety and Depression Scale was used to assess patients' psychological symptoms.
RESULTS
We found that 61.7% of patients reported that both their treatment goal and their oncologist's treatment goal were noncurative, whereas 19.3% reported that both their goal and their oncologist's goal were to cure their cancer, 13.9% reported that their goal was to cure their cancer whereas their oncologist's goal was noncurative, and 5% reported that their goal was noncurative whereas their oncologist's goal was curative. Patients who reported both their goal and their oncologist's goal as noncurative had higher levels of depression (B=0.99; P=.021) and anxiety symptoms (B=1.01; P=.015) compared with those who reported that both their goal and their oncologist's goal was curative. Patients with discordant perceptions of their goal and their oncologist's goal reported higher anxiety symptoms (B=1.47; P=.004) compared with those who reported that both their goal and their oncologist's goal were curative.
CONCLUSIONS
One-fifth of patients with incurable cancer reported that both their treatment goal and their oncologist's goal were to cure their cancer. Patients who acknowledged the noncurative intent of their treatment and those who perceived that their treatment goal was discordant from that of their oncologist reported greater psychological distress.
背景
研究表明，癌症患者在预后理解方面存在差距。然而，很少有研究探讨患者对自己治疗目标的看法与他们对肿瘤医生治疗目标的看法，以及这些观点与他们心理困扰的关系。
方法
我们对 559 例患有不可治愈的肺癌、胃肠道癌、乳腺癌和脑癌的患者进行了横断面研究。采用预后和治疗观念问卷评估患者对自己治疗目标和肿瘤医生治疗目标的报告，采用医院焦虑抑郁量表评估患者的心理症状。
结果
我们发现，61.7%的患者报告说，他们的治疗目标和肿瘤医生的治疗目标都是非治愈性的，而 19.3%的患者报告说，他们的目标和肿瘤医生的目标都是治愈癌症，13.9%的患者报告说他们的目标是治愈癌症，而肿瘤医生的目标是非治愈性的，5%的患者报告说他们的目标是非治愈性的，而肿瘤医生的目标是治愈性的。报告自己的目标和肿瘤医生的目标都是非治愈性的患者，抑郁症状（B=0.99；P=.021）和焦虑症状（B=1.01；P=.015）水平较高，与报告自己的目标和肿瘤医生的目标都是治愈性的患者相比。对自己的目标和肿瘤医生的目标有不同看法的患者，焦虑症状（B=1.47；P=.004）较高，与报告自己的目标和肿瘤医生的目标都是治愈性的患者相比。
结论
五分之一患有不可治愈癌症的患者报告说，他们的治疗目标和肿瘤医生的目标都是治愈癌症。承认治疗非治愈性意图的患者和那些认为自己的治疗目标与肿瘤医生的目标不一致的患者报告了更大的心理困扰。
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