Department of Medical Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Department of Internal Medicine, Seoul Medical Center, Seoul, South Korea.
Support Care Cancer. 2022 Sep;30(9):7431-7438. doi: 10.1007/s00520-022-07143-x. Epub 2022 May 27.
A multicenter prospective study to evaluate the feasibility of Physician Orders for Life-Sustaining Treatment (POLST) in oncology practice was conducted between June and December 2017. Factors associated with POLST completion and follow-up outcomes were analyzed.
Patients with terminal cancer, aged ≥ 20 years and capable of communicating, were enrolled from seven hospitals. Demographic data were collected and updated in February 2021. Descriptive statistics and logistic regression analyses were conducted.
Among 336 patients, 105 (31.3%) completed POLST, which was more common in male (p = 0.029), patients with better performance (p < 0.001), longer duration of follow-up (p = 0.037), and those living with children (p = 0.023). Male (odds ratio [OR], 2.30; 95% confidence interval [CI], 1.17-3.51; p = 0.012), having good performance status (OR, 2.38; 95% CI, (1.35-4.19); p = 0.003), transferred from other departments (OR, 0.50; 95% CI, (0.26-0.98); p = 0.045), and living with children (OR, 1.94; 95% CI, (1.11-3.47); p = 0.020) were significant predictors of POLST completion. Patients who completed POLST were more likely to enroll in hospice care (p = 0.012) or experience out-of-hospital death (p = 0.016) at end-of-life (EOL). POLST completion showed a strong association with hospice enrollment at EOL (OR, 2.61; 95% CI, (1.08-6.32); p = 0.033).
Gender, patient performance, timing of POLST discussion, and type of household were associated with POLST completion. Earlier discussions on POLST could reinforce hospice enrollment or non-aggressive EOL care.
本项 2017 年 6 月至 12 月开展的多中心前瞻性研究旨在评估医生对延续性治疗的指令（POLST）在肿瘤学实践中的可行性。分析了与 POLST 完成和随访结果相关的因素。
从七家医院招募了年龄≥20 岁且能够沟通的终末期癌症患者。收集并于 2021 年 2 月更新了人口统计学数据。进行了描述性统计和逻辑回归分析。
在 336 名患者中，有 105 名（31.3%）完成了 POLST，其中男性（p=0.029）、功能状态较好（p<0.001）、随访时间较长（p=0.037）和与子女同住的患者（p=0.023）更常完成 POLST。男性（比值比[OR]，2.30；95%置信区间[CI]，1.17-3.51；p=0.012）、功能状态良好（OR，2.38；95% CI，（1.35-4.19）；p=0.003）、从其他科室转来（OR，0.50；95% CI，（0.26-0.98）；p=0.045）和与子女同住（OR，1.94；95% CI，（1.11-3.47）；p=0.020）是 POLST 完成的显著预测因素。完成 POLST 的患者更有可能在临终时（EOL）入住临终关怀机构（p=0.012）或出现院外死亡（p=0.016）。POLST 完成与 EOL 时的临终关怀入院有很强的关联（OR，2.61；95% CI，（1.08-6.32）；p=0.033）。
性别、患者功能状态、POLST 讨论时间和家庭类型与 POLST 完成情况相关。更早地讨论 POLST 可以加强临终关怀入院或非积极的 EOL 护理。
