Department of IQ healthcare, Ethics of healthcare, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands.
Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands.
BMC Palliat Care. 2020 Jul 20;19(1):109. doi: 10.1186/s12904-020-00618-w.
In ageing Western societies, many older persons live with and die from cancer. Despite that present-day healthcare aims to be patient-centered, scientific literature has little knowledge to offer about how cancer and its treatment impact older persons' various outlooks on life and underlying life values. Therefore, the aims of this paper are to: 1) describe outlooks on life and life values of older people (≥ 70) living with incurable cancer; 2) elicit how healthcare professionals react and respond to these.
Semi-structured qualitative interviews with 12 older persons with advanced cancer and two group interviews with healthcare professionals were held and followed by an analysis with a grounded theory approach.
Several themes and subthemes emerged from the patient interview study: a) handling incurable cancer (the anticipatory outlook on "a reduced life", hope and, coping with an unpredictable disease) b) being supported by others ("being there", leaving a legacy, and having reliable healthcare professionals) and; c) making end-of-life choices (anticipatory fears, and place of death). The group interviews explained how healthcare professionals respond to the abovementioned themes in palliative care practice. Some barriers for (open) communication were expressed too by the latter, e.g., lack of continuity of care and advance care planning, and patients' humble attitudes.
Older adults living with incurable cancer showed particular outlooks on life and life values regarding advanced cancer and the accompanying last phase of life. This paper could support healthcare professionals and patients in jointly exploring and formulating these outlooks and values in the light of treatment plans.
在老龄化的西方社会中，许多老年人患有癌症并死于癌症。尽管当今的医疗保健旨在以患者为中心，但科学文献对于癌症及其治疗如何影响老年人的各种人生观和潜在的生活价值观知之甚少。因此，本文的目的是：1）描述患有绝症的老年人（≥70 岁）的人生观和生活价值观；2）了解医护人员对此的反应和回应。
对 12 名患有晚期癌症的老年人和 2 名医护人员进行半结构化定性访谈，并进行扎根理论分析。
从患者访谈研究中出现了几个主题和子主题：a）处理绝症（对“生命缩短”的预期、希望和应对不可预测疾病的态度）b）获得他人的支持（“陪伴在旁”、留下遗产和有可靠的医护人员）；c）做出临终选择（对死亡的预期恐惧和死亡地点）。小组访谈解释了医护人员在姑息治疗实践中对上述主题的反应。后者还表达了一些沟通障碍，例如护理连续性和预立医疗照护计划的缺乏以及患者的谦逊态度。
患有绝症的老年人对晚期癌症和伴随而来的生命最后阶段表现出特定的人生观和生活价值观。本文可以为医护人员和患者提供支持，共同探讨和制定这些观点和价值观，以制定治疗计划。
