Department of Anesthesia, University of Iowa Carver College of Medicine, 200 Hawkins Dr, Iowa City, IA, 52242, USA.
Department of Surgery, University of Pennsylvania Health System, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Support Care Cancer. 2022 Jun;30(6):5175-5186. doi: 10.1007/s00520-022-06938-2. Epub 2022 Mar 4.
The Patient Dignity Question (PDQ), "What do I need to know about you as a person to give you the best care possible?" is a validated instrument designed to assess patient priorities and stressors. Administration of the PDQ has been demonstrated to improve patient-provider relationships. The PDQ has been evaluated in multiple settings, but never as a standard component of palliative care consultation. The primary objectives of this study were to determine the feasibility of PDQ screening in palliative care consultation and to characterize responses. The secondary objective was to determine patient and disease factors associated with PDQ response among patients diagnosed with cancer.
PDQ responses were collected from 2015 to 2017, and patient survival data collected through 2018. A codebook was developed to categorize responses using literature review and template analysis; coding was performed until thematic saturation was achieved. We descriptively analyzed thematic distribution among responders and performed multivariable multinomial regression to determine the association between patient characteristics and PDQ response.
Response to the PDQ was documented in 2053/5002 consultations (41.1%); 1877 patient responses were included in final analysis. A total of 544 (29.5%) patients referenced illness-related concerns, 879 (46.8%) shared personal insights, and 283 (15.1%) cited interpersonal relationships. Younger patients frequently reported illness-related concerns; older respondents (age > 65) often responded with insights into their identity. Patients' responses evaluated less than 1 year before death were more likely to focus upon identity and interpersonal relationships than illness-related concerns.
The PDQ can be used as a means of eliciting values among patients with cancer. Variations in response pattern suggest that approaches to distress may be tailored to age and proximity to death.
患者尊严问题（PDQ），“为了尽可能为您提供最佳护理，我需要了解您的哪些个人信息？”是一种经过验证的工具，旨在评估患者的优先事项和压力源。PDQ 的管理已被证明可以改善医患关系。PDQ 已在多种环境中进行了评估，但从未作为姑息治疗咨询的标准组成部分。这项研究的主要目的是确定 PDQ 筛选在姑息治疗咨询中的可行性并描述其结果。次要目标是确定与癌症诊断患者的 PDQ 反应相关的患者和疾病因素。
PDQ 反应于 2015 年至 2017 年收集，患者生存数据收集至 2018 年。通过文献回顾和模板分析开发了一个代码本对反应进行分类；直到达到主题饱和为止进行编码。我们对应答者的主题分布进行了描述性分析，并进行了多变量多项回归分析，以确定患者特征与 PDQ 反应之间的关联。
在 5002 次咨询中的 2053 次（41.1%）记录了对 PDQ 的反应；最终分析中纳入了 1877 名患者的反应。共有 544 名（29.5%）患者提到了与疾病相关的问题，879 名（46.8%）患者分享了个人见解，283 名（15.1%）患者提到了人际关系。年轻患者经常报告与疾病相关的问题；年龄较大的受访者（年龄>65 岁）通常会对自己的身份有深刻的了解。在死亡前不到 1 年评估的患者的反应更可能关注身份和人际关系，而不是与疾病相关的问题。
PDQ 可用于在癌症患者中引出价值观。反应模式的变化表明，可以根据年龄和接近死亡的程度来调整对压力的处理方法。
