Department of Medicine, Duke University School of Medicine, Durham, NC.
Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC.
JCO Oncol Pract. 2021 Feb;17(2):e94-e100. doi: 10.1200/OP.20.00657. Epub 2021 Jan 13.
Advance care planning (ACP) is a process in which patients share their values, goals, and preferences regarding future medical care. ACP can improve care quality, yet may be challenging to address for patients with cancer. We sought to characterize key components of ACP in patients with cancer as compared with patients with noncancer serious illness referred to palliative care (PC).
We performed a retrospective cross-sectional analysis of initial outpatient PC visits from the Quality Data Collection Tool for PC database from 2015 to 2019. Quality Data Collection Tool is a web-based point-of-care specialty PC registry to track quality metrics.
We analyzed 1,604 patients with cancer and 1,094 patients without cancer: 44% of patients were female, 87% were White, and 98% were non-Hispanic. The average age was 72.2 years (standard deviation [SD] 15.4). Patients with cancer were on average younger than patients without cancer (66.5 [SD: 13.9] 80.5 [SD: 13.8]) and had a higher Palliative Performance Scale (PPS) (59.5 [SD: 22.4] 33.4 [SD: 25.1]). In our unadjusted comparison, patients with cancer were less likely to be DNR/DNI (37% 53%; < .0001) and less likely to have an advance directive (53% 73%; < .0001); rates of healthcare proxy identification were similar (92.8% 94.5%; = .10). These differences did not persist when we accounted for age, race, sex, and PPS, with age being the primary explanatory factor.
Despite having serious illness meriting PC referral, many patients with cancer in our study lacked advance directives. This highlights both the important role of oncologists in facilitating ACP and the utility of PC playing a complementary role.
预先医疗照护计划（advance care planning，ACP）是一个让患者分享其对未来医疗照护之价值观、目标和偏好的过程。ACP 可以提高医疗照护质量，但对于癌症患者来说，可能具有挑战性。我们试图描述癌症患者与接受缓和医疗（palliative care，PC）转诊的非癌症严重疾病患者之间 ACP 的关键组成部分。
我们对 2015 年至 2019 年期间 PC 质量数据采集工具数据库中的首次门诊 PC 就诊进行了回顾性横断面分析。PC 质量数据采集工具是一个基于网络的特殊 PC 注册工具，用于跟踪质量指标。
我们分析了 1604 例癌症患者和 1094 例非癌症患者：44%的患者为女性，87%为白人，98%为非西班牙裔。平均年龄为 72.2 岁（标准差[SD]为 15.4）。与非癌症患者相比，癌症患者的平均年龄更小（66.5[SD：13.9] 80.5[SD：13.8]），且 PPS 评分更高（59.5[SD：22.4] 33.4[SD：25.1]）。在未调整的比较中，癌症患者更不可能是 DNR/DNI（37% 53%；<.0001），也更不可能有预先医疗指示（53% 73%；<.0001）；医疗代理人的识别率相似（92.8% 94.5%；=.10）。当我们考虑年龄、种族、性别和 PPS 时，这些差异并没有持续存在，年龄是主要的解释因素。
尽管有需要接受 PC 转诊的严重疾病，但我们研究中的许多癌症患者缺乏预先医疗指示。这既突出了肿瘤医生在促进 ACP 方面的重要作用，也突出了 PC 在发挥补充作用方面的实用性。
