Hatano Yutaka, Morita Tatsuya, Mori Masanori, Maeda Isseki, Oyamada Shunsuke, Naito Akemi Shirado, Oya Kiyofumi, Sakashita Akihiro, Ito Satoko, Hiratsuka Yusuke, Tsuneto Satoru
Department of Palliative Care, Daini Kyoritsu Hospital, Kawanishi, Japan.
Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
Palliat Support Care. 2021 Dec;19(6):646-655. doi: 10.1017/S1478951521000080.
The present study aims were (1) to identify the proportion of terminally ill cancer patients with desire for hastened death (DHD) receiving specialized palliative care, (2) to identify the reasons for DHD, and (3) to classify patients with DHD into some interpretable subgroups.
Advanced cancer patients admitted to 23 inpatients hospices/palliative care units in 2017 were enrolled. Data were prospectively obtained by the primarily responsible physicians. The presence/absence of DHD and reasons for DHD were recorded. A cluster analysis was performed to identify patterns of subgroups in patients with DHD.
Data from 971 patients, whose Richmond Agitation-Sedation Scale score at admission was zero and who died in palliative care units, were analyzed. The average age was 72 years, common primary cancer sites were the gastrointestinal tract (31%) and the liver/biliary ducts/pancreas (19%). A total of 174 patients (18%: 95% confidence interval, 16-20) expressed DHD. Common reasons for DHD were dependency (45%), burden to others (28%), meaninglessness (24%), and inability to engage in pleasant activities (24%). We identified five clusters of patients with DHD: cluster 1 (35%, 61/173): "physical distress," cluster 2 (21%, 37/173): "dependent and burdensome," cluster 3 (19%, 33/173): "hopelessness," cluster 4 (17%, 30/173): "profound fatigue," and cluster 5 (7%, 12/173): "extensive existential suffering."
A considerable number of patients expressed DHD and could be categorized into five subgroups. These findings may contribute to the development of therapeutic strategies.
本研究旨在（1）确定接受专科姑息治疗的晚期癌症患者中渴望加速死亡（DHD）的比例，（2）确定DHD的原因，以及（3）将有DHD的患者分类为一些可解释的亚组。
纳入2017年入住23家住院临终关怀/姑息治疗单位的晚期癌症患者。由主要负责医生前瞻性收集数据。记录是否存在DHD以及DHD的原因。进行聚类分析以确定有DHD患者的亚组模式。
分析了971例患者的数据，这些患者入院时里士满躁动镇静量表评分为零且在姑息治疗单位死亡。平均年龄为72岁，常见的原发癌部位是胃肠道（31%）和肝/胆管/胰腺（19%）。共有174例患者（18%：95%置信区间，16 - 20）表示有DHD。DHD的常见原因是依赖（45%）、给他人造成负担（28%）、无意义感（24%）以及无法参与愉快活动（24%）。我们确定了有DHD患者的五个聚类：聚类1（35%，61/173）：“身体痛苦”，聚类2（21%，37/173）：“依赖且负担重”，聚类3（19%，33/173）：“绝望”，聚类4（17%，30/173）：“极度疲劳”，聚类5（7%，12/173）：“广泛的生存痛苦”。
相当数量的患者表示有DHD，且可分为五个亚组。这些发现可能有助于制定治疗策略。
