Supportive Care Department, Institut Curie, Palliative Care Unit, Paris, France; PSL, Paris Sciences Lettre, University Paris, Paris, France.
Clinical Research Department, Institut Curie, Biometric Unit, Paris, France; PSL, Paris Sciences Lettre, University Paris, Paris, France.
J Pain Symptom Manage. 2021 Feb;61(2):331-341.e8. doi: 10.1016/j.jpainsymman.2020.07.026. Epub 2020 Jul 31.
Advance care planning is essential to enable informed medical decisions to be made and to reduce aggressiveness in end-of-life (EOL) care.
This study aimed to explore whether a question prompt list (QPL) adapted to French language and culture could promote discussions, particularly on prognosis and EOL issues, among advanced cancer patients attending outpatient palliative care (PC) consultations.
In this multicenter randomized study, patients assigned to the intervention arm received a QPL to help them prepare for the next consultation one month later. The main inclusion criteria were advanced cancer patients referred to the PC team with an estimated life expectancy of less than one year. The primary endpoint was the number of questions raised, globally and by topic. The secondary objectives were the impact of the QPL on psychological symptoms, quality of life, satisfaction with care, and coping styles at two months.
Patients (n = 71) in the QPL arm asked more questions (mean 21.8 vs. 18.2, P = 0.03) than patients in the control arm (n = 71), particularly on PC (5.6 vs. 3.7, P = 0.012) and EOL issues (2.2 vs. 1, P = 0.018) but not on prognosis (4.3 vs. 3.6, not specified). At two months, there was no change in anxiety, depression, or quality of life in either arm; patient satisfaction with doctors' technical skills was scored higher (P = 0.024), and avoidance coping responses were less frequent (self-distraction, P = 0.015; behavioral disengagement, P = 0.025) in the QPL arm.
Questions on PC and EOL issues in outpatient PC consultations were more frequent, and patient satisfaction was better when a QPL was made available before the consultation.
预先医疗照护计划对于做出知情的医疗决策以及减少末期医疗（EOL）护理的激进性至关重要。
本研究旨在探索适应法语语言和文化的问题提示清单（QPL）是否可以促进晚期癌症患者在接受姑息治疗（PC）门诊咨询时进行讨论，特别是关于预后和 EOL 问题的讨论。
在这项多中心随机研究中，被分配到干预组的患者收到了一份 QPL，以帮助他们为一个月后下一次咨询做好准备。主要纳入标准是被 PC 团队转介、预计生存时间不足一年的晚期癌症患者。主要终点是提出的问题总数，以及按主题分类的问题数量。次要目标是 QPL 对两个月时心理症状、生活质量、护理满意度和应对方式的影响。
QPL 组（n=71）的患者提出的问题多于对照组（n=71）（平均 21.8 个 vs. 18.2 个，P=0.03），特别是在 PC（5.6 个 vs. 3.7 个，P=0.012）和 EOL 问题（2.2 个 vs. 1 个，P=0.018）方面，但在预后方面没有差异（4.3 个 vs. 3.6 个，未指定）。在两个月时，两组患者的焦虑、抑郁或生活质量均无变化；患者对医生技术技能的满意度评分更高（P=0.024），回避应对方式（自我分心，P=0.015；行为脱离，P=0.025）较少。
在门诊 PC 咨询中，使用 QPL 后，PC 和 EOL 问题的讨论更频繁，患者满意度更高。
