癌症与非癌症原因导致的患者临终前一年：对失去亲人的亲属进行的回顾性横断面调查。
The last year of life for patients dying from cancer vs. non-cancer causes: a retrospective cross-sectional survey of bereaved relatives.
机构信息
Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Faculty of Medicine and University Hospital Cologne, Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany.
出版信息
Support Care Cancer. 2022 Jun;30(6):4971-4979. doi: 10.1007/s00520-022-06908-8. Epub 2022 Feb 21.
PURPOSE
To compare health care experiences of patients with cancer or non-cancer diseases in their last year of life.
METHODS
A cross-sectional post-bereavement survey was conducted using an adapted German version of the VOICES questionnaire (VOICES-LYOL-Cologne). Differences in the reported experiences were assessed using a two-sided Pearson's chi-square test and Mann-Whitney U test.
RESULTS
We collected data from 351 bereaved relatives. More than half of non-cancer patients were not informed that their disease could lead to death (p < 0.001). When this was communicated, in 46.7% of non-cancer and 64.5% of cancer patients, it was reported by the hospital doctor (p = 0.050). In all, 66.9% of non-cancer and 41.6% of cancer patients were not informed about death being imminent (p < 0.001). On average, non-cancer patients had significantly fewer transitions and hospital stays in their last year of life (p = 0.014; p = 0.008, respectively). Non-cancer patients were treated more often by general practitioners, and cancer patients were treated more often by specialists (p = 0.002; p = 0.002, respectively). A substantially lower proportion of non-cancer patients were treated by at least one member of or in the setting of general or specialized palliative care (p < 0.001).
CONCLUSIONS
Non-cancer patients experience disadvantages in communication regarding their care and in access to specialized palliative care in their last year of life compared to cancer patients. Regarding the assessment of palliative care needs and the lack of communication of an incurable disease, non-cancer patients are underserved. An early identification of patients requiring palliative care is a major public health concern and should be addressed irrespective of diagnosis.
TRIAL REGISTRATION
Prospectively registered by the German Clinical Trials Register (DRKS00011925, data of registration: 13.06.2017).
目的
比较癌症和非癌症患者在生命最后一年的医疗保健体验。
方法
使用经过改编的德国版 VOICES 问卷（VOICES-LYOL-Cologne）进行了一项横断面的事后丧亲调查。使用双侧 Pearson 卡方检验和 Mann-Whitney U 检验评估报告体验的差异。
结果
我们收集了 351 名丧亲亲属的数据。超过一半的非癌症患者未被告知其疾病可能导致死亡（p<0.001）。当告知时，在 46.7%的非癌症患者和 64.5%的癌症患者中，由医院医生报告（p=0.050）。总体而言，66.9%的非癌症患者和 41.6%的癌症患者未被告知死亡即将来临（p<0.001）。非癌症患者在生命的最后一年中平均进行的过渡和住院治疗次数明显较少（p=0.014；p=0.008，分别）。非癌症患者更多地由全科医生治疗，而癌症患者更多地由专科医生治疗（p=0.002；p=0.002，分别）。在生命的最后一年，接受至少一名普通或专门姑息治疗团队成员或在普通或专门姑息治疗环境中治疗的非癌症患者比例要低得多（p<0.001）。
结论
与癌症患者相比，非癌症患者在生命的最后一年中在其护理沟通以及获得专门的姑息治疗方面处于劣势。在姑息治疗需求的评估以及绝症的沟通方面，非癌症患者的服务不足。早期识别需要姑息治疗的患者是一个主要的公共卫生问题，无论诊断如何都应予以解决。
试验注册
由德国临床试验注册处（DRKS00011925）前瞻性注册，数据注册日期：2017 年 6 月 13 日。
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