Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, FA 21, 9713 AV, Groningen, The Netherlands.
Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Support Care Cancer. 2021 Jul;29(7):3849-3856. doi: 10.1007/s00520-020-05945-5. Epub 2020 Dec 22.
To investigate the treatment goals of older patients with non-curable cancer, whether those goals changed over time, and if so, what triggered those changes.
We performed a descriptive and qualitative analysis using the Outcome Prioritization Tool (OPT) to assess patient goals across four conversations with general practitioners (GPs) over 6 months. Text entries from electronic patient records (hospital and general practice) were then analyzed qualitatively for this period.
Of the 29 included patients, 10 (34%) rated extending life and 9 (31%) rated maintaining independence as their most important goals. Patients in the last year before death (late phase) prioritized extending life less often (3 patients; 21%) than those in the early phase (7 patients; 47%). Goals changed for 16 patients during follow-up (12 in the late phase). Qualitative analysis revealed three themes that explained the baseline OPT scores (prioritizing a specific goal, rating a goal as unimportant, and treatment choices related to goals). Another three themes related to changes in OPT scores (symptoms, disease course, and life events) and stability of OPT scores (stable situation, disease-unrelated motivation, and stability despite symptoms).
Patients most often prioritized extending life as the most important goal. However, priorities differed in the late phase of the disease, leading to changed goals. Triggers for change related to both the disease (e.g., symptoms and course) and to other life events. We therefore recommend that goals should be discussed repeatedly, especially near the end of life.
OPTion study: NTR5419.
调查无法治愈的癌症老年患者的治疗目标，这些目标是否随时间发生变化，如果发生了变化，是什么引发了这些变化。
我们使用结局优先化工具（Outcome Prioritization Tool，OPT）进行描述性和定性分析，以评估在 6 个月内与全科医生进行的 4 次对话中患者的目标。在此期间，还对电子病历（医院和全科医生）中的文字记录进行了定性分析。
在 29 名纳入的患者中，10 名（34%）将延长生命和 9 名（31%）将维持独立性评为最重要的目标。在死亡前的最后一年（晚期），患者对延长生命的重视程度低于早期（7 名患者，47%）。在随访期间，16 名患者的目标发生了变化（晚期 12 名）。定性分析揭示了三个解释 OPT 得分的主题（优先考虑特定目标、将目标评为不重要、与目标相关的治疗选择）。另外三个主题与 OPT 得分的变化有关（症状、疾病进程和生活事件）和 OPT 得分的稳定性（稳定的情况、与疾病无关的动机以及尽管有症状但仍保持稳定）。
患者最常将延长生命作为最重要的目标。然而，在疾病的晚期，优先事项有所不同，导致目标发生变化。变化的触发因素与疾病（如症状和病程）以及其他生活事件有关。因此，我们建议应反复讨论目标，尤其是在生命的晚期。
OPTion 研究：NTR5419。
