Department of Medical Psychology, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
JCO Oncol Pract. 2022 Nov;18(11):e1818-e1830. doi: 10.1200/OP.22.00185. Epub 2022 Oct 6.
When deliberating palliative cancer treatment, insight into patients' attitudes toward striving for quality of life (QL) and length of life (LL) may facilitate goal-concordant care. We investigated the (1) attitudes of patients with advanced cancer toward striving for QL and/or LL and whether these change over time, and (2) characteristics associated with these attitudes (over time).
We performed a secondary analysis of a randomized controlled trial on improving shared decision making (SDM), without differentiation between intervention arms. Patients (n = 173) with advanced cancer, a median life expectancy of < 12 months without anticancer treatment, and a median survival benefit of < 6 months from systemic therapy were included in seven Dutch hospitals. We used audio-recorded consultations and surveys at baseline (T0), shortly after the consultation (T2), at 3 and 6 months (T3 and T4). Primary outcomes were patients' attitudes toward striving for QL and LL (Quality Quantity Questionnaire; T2, T3, and T4).
Overall, patients' attitudes toward striving for QL became less positive over 6 months ( < .01); attitudes toward striving for LL did not change on group level. Studying individual patients, 76% showed changes in their attitudes toward striving for QL and/or LL at some point during the study, which occurred in various directions. More helplessness/hopelessness ( < .001), less fighting spirit ( < .05), less state anxiety ( < .001), and more observed SDM ( < .05) related to more positive attitudes toward striving for QL. Lower education, less helplessness/hopelessness, more fighting spirit, and more state anxiety ( < .001) related to more positive attitudes toward striving for LL.
Oncologists may explore patients' attitudes toward striving for QL and LL repeatedly and address patients' coping style and emotions during SDM to facilitate goal-concordant care throughout the last phase of life.
在审议姑息性癌症治疗时，了解患者对追求生活质量（QL）和寿命（LL）的态度，可能有助于实现目标一致的护理。我们调查了（1）晚期癌症患者对追求 QL 和/或 LL 的态度，以及这些态度是否随时间变化，以及（2）随时间变化与这些态度相关的特征。
我们对一项旨在改善共享决策（SDM）的随机对照试验进行了二次分析，而不分干预组。纳入了七家荷兰医院的 173 名晚期癌症患者，预计无抗癌治疗的生存期中位数<12 个月，系统治疗的中位生存获益<6 个月。我们使用音频记录的咨询和基线时（T0）、咨询后不久（T2）、3 个月（T3）和 6 个月（T4）的调查。主要结局是患者对追求 QL 和 LL 的态度（质量数量问卷；T2、T3 和 T4）。
总体而言，患者对追求 QL 的态度在 6 个月内变得不那么积极（<0.01）；群体水平上对追求 LL 的态度没有变化。研究个体患者，76%的患者在研究期间的某个时间点对追求 QL 和/或 LL 的态度发生了变化，且变化方向各异。更多的无助/绝望感（<0.001）、较少的斗志（<0.05）、较少的状态焦虑（<0.001）和更多观察到的 SDM（<0.05）与对追求 QL 的更积极态度相关。较低的教育水平、较少的无助/绝望感、更多的斗志和更多的状态焦虑（<0.001）与对追求 LL 的更积极态度相关。
肿瘤医生可能会反复探讨患者对追求 QL 和 LL 的态度，并在 SDM 期间解决患者的应对方式和情绪，以在生命的最后阶段促进目标一致的护理。
