患者和照护者对晚期癌症老年患者预后估计的一致性。
Patient and caregiver agreement on prognosis estimates for older adults with advanced cancer.
机构信息
Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York.
Department of Geriatrics, Salvador Zubiran National Institute of Medical Sciences and Nutrition, Mexico City, Mexico.
出版信息
Cancer. 2021 Jan 1;127(1):149-159. doi: 10.1002/cncr.33259. Epub 2020 Oct 9.
BACKGROUND
Disagreements between patients and caregivers about treatment benefits, care decisions, and patients' health are associated with increased patient depression as well as increased caregiver anxiety, distress, depression, and burden. Understanding the factors associated with disagreement may inform interventions to improve the aforementioned outcomes.
METHODS
For this analysis, baseline data were obtained from a cluster-randomized geriatric assessment trial that recruited patients aged ≥70 years who had incurable cancer from community oncology practices (University of Rochester Cancer Center 13070; Supriya G. Mohile, principal investigator). Patient and caregiver dyads were asked to estimate the patient's prognosis. Response options were 0 to 6 months, 7 to 12 months, 1 to 2 years, 2 to 5 years, and >5 years. The dependent variable was categorized as exact agreement (reference), patient-reported longer estimate, or caregiver-reported longer estimate. The authors used generalized estimating equations with multinomial distribution to examine the factors associated with patient-caregiver prognostic estimates. Independent variables were selected using the purposeful selection method.
RESULTS
Among 354 dyads (89% of screened patients were enrolled), 26% and 22% of patients and caregivers, respectively, reported a longer estimate. Compared with dyads that were in agreement, patients were more likely to report a longer estimate when they screened positive for polypharmacy (β = 0.81; P = .001), and caregivers reported greater distress (β = 0.12; P = .03). Compared with dyads that were in agreement, caregivers were more likely to report a longer estimate when patients screened positive for polypharmacy (β = 0.82; P = .005) and had lower perceived self-efficacy in interacting with physicians (β = -0.10; P = .008).
CONCLUSIONS
Several patient and caregiver factors were associated with patient-caregiver disagreement about prognostic estimates. Future studies should examine the effects of prognostic disagreement on patient and caregiver outcomes.
背景
患者与照护者之间在治疗益处、护理决策以及患者健康方面的意见分歧与患者抑郁以及照护者焦虑、痛苦、抑郁和负担增加有关。了解导致意见分歧的因素可能有助于制定干预措施来改善上述结果。
方法
本分析基于一项老年综合评估试验的基线数据，该试验招募了来自社区肿瘤学实践的年龄≥70 岁、患有无法治愈癌症的患者（罗切斯特大学癌症中心 13070；Supriya G. Mohile，主要研究者）。要求患者和照护者二人组估计患者的预后。回答选项为 0 至 6 个月、7 至 12 个月、1 至 2 年、2 至 5 年和>5 年。因变量分为准确一致（参考）、患者报告的更长估计或照护者报告的更长估计。作者使用具有多项分布的广义估计方程来研究与患者-照护者预后估计相关的因素。使用有目的选择法选择自变量。
结果
在 354 对二人组（89%接受筛查的患者被纳入）中，分别有 26%和 22%的患者和照护者报告了更长的估计。与意见一致的二人组相比，当患者药物治疗方案复杂（β=0.81；P=.001）且照护者痛苦程度更大（β=0.12；P=.03）时，患者更有可能报告更长的估计。与意见一致的二人组相比，当患者药物治疗方案复杂（β=0.82；P=.005）且患者对与医生互动的自我效能感较低（β=-0.10；P=.008）时，照护者更有可能报告更长的估计。
结论
一些患者和照护者因素与患者-照护者在预后估计方面的意见分歧有关。未来的研究应该研究预后分歧对患者和照护者结局的影响。
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