Serey Kevin, Cambriel Amélie, Pollina-Bachellerie Adrien, Lotz Jean-Pierre, Philippart François
Anesthesiology and Intensive Care Medicine Department, APHP-Ambroise Paré University Hospital, 92100 Boulogne-Billancourt, France.
REQUIEM (Research/Reflexion on End of Life Support Quality in Everyday Medical Practice) Study Group, 75015 Paris, France.
J Clin Med. 2022 Feb 23;11(5):1195. doi: 10.3390/jcm11051195.
Patients living with cancer often experience serious adverse events due to their condition or its treatments. Those events may lead to a critical care unit admission or even result in death. One of the most important but challenging parts of care is to build a care plan according to the patient's wishes, meeting their goals and values. Advance directives (ADs) allow everyone to give their preferences in advance regarding life sustaining treatments, continuation, and withdrawal or withholding of treatments in case one is not able to speak their mind anymore. While the absence of ADs is associated with a greater probability of receiving unwanted intensive care around the end of their life, their existence correlates with the respect of the patient's desires and their greater satisfaction. Although progress has been made to promote ADs' completion, they are still scarcely used among cancer patients in many countries. Several limitations to their acceptance and use can be detected. Efforts should be made to provide tailored solutions for the identified hindrances. This narrative review aims to depict the situation of ADs in the oncology context, and to highlight the future areas of improvement.
癌症患者常常因其病情或治疗而经历严重的不良事件。这些事件可能导致患者入住重症监护病房，甚至死亡。护理中最重要但也最具挑战性的部分之一，是根据患者的意愿制定护理计划，满足他们的目标和价值观。预先指示（ADs）使每个人都能提前表达自己对维持生命治疗、治疗的延续、中止或停止的偏好，以防有一天无法再表达自己的想法。虽然没有预先指示与在生命末期接受不必要的重症监护的可能性增加有关，但预先指示的存在与对患者意愿的尊重以及更高的满意度相关。尽管在促进预先指示的完成方面已经取得了进展，但在许多国家，癌症患者中预先指示的使用率仍然很低。可以发现其接受和使用存在若干限制。应努力为已确定的障碍提供量身定制的解决方案。本叙述性综述旨在描述肿瘤学背景下预先指示的情况，并突出未来需要改进的领域。
