Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Palliat Med. 2023 May;37(5):740-748. doi: 10.1177/02692163231155511. Epub 2023 Feb 18.
Many patients with advanced cancer have misperceptions of their prognosis, which may impact end-of-life decision-making. Data regarding associations between prognostic perceptions over time and end-of-life care outcomes are lacking.
To describe patients' perceptions of their prognosis with advanced cancer and examine associations between these perceptions and end-of-life care outcomes.
Secondary analysis of longitudinal data from a randomized controlled trial of a palliative care intervention for patients with newly diagnosed incurable cancer.
SETTING/PARTICIPANTS: Conducted at an outpatient cancer center in the northeastern United States and patients were within 8 weeks of a diagnosis with incurable lung or non-colorectal gastrointestinal cancer.
We enrolled 350 patients in the parent trial, of which 80.5% (281/350) died during the study period. Overall, 59.4% (164/276) of patients reported they were terminally ill, and 66.1% (154/233) reported that their cancer was likely curable at the assessment closest to death. Patient acknowledgment of terminal illness was only associated with lower risk of hospitalizations in the last 30 days of life (OR = 0.52, = 0.025). Patients who reported their cancer as likely curable were less likely to utilize hospice (OR = 0.25, = 0.002) or die at home (OR = 0.56, = 0.043), and they were more likely to be hospitalized in the last 30 days of life (OR = 2.28, = 0.011).
Patients' perceptions of their prognosis are associated with important end-of-life care outcomes. Interventions are needed to enhance patients' perceptions of their prognosis and optimize their end-of-life care.
许多晚期癌症患者对自己的预后存在误解，这可能会影响临终决策。目前缺乏关于随时间推移预测感知与临终关怀结局之间关联的数据。
描述晚期癌症患者对自己预后的看法，并研究这些看法与临终关怀结局之间的关联。
对一项新诊断为不可治愈癌症患者姑息治疗干预的随机对照试验的纵向数据进行二次分析。
地点/参与者：在美国东北部的一家门诊癌症中心进行，患者在被诊断患有不可治愈的肺癌或非结直肠胃肠道癌症后 8 周内入组。
我们在母试验中招募了 350 名患者，其中 80.5%（281/350）在研究期间死亡。总体而言，59.4%（164/276）的患者报告自己处于终末期，66.1%（154/233）报告在接近死亡时认为自己的癌症可能治愈。患者承认自己处于终末期仅与生命最后 30 天住院风险降低相关（OR=0.52，=0.025）。报告自己的癌症可能治愈的患者不太可能使用临终关怀（OR=0.25，=0.002）或在家中死亡（OR=0.56，=0.043），并且他们在生命最后 30 天住院的可能性更高（OR=2.28，=0.011）。
患者对自己预后的看法与重要的临终关怀结局有关。需要干预措施来增强患者对自己预后的看法并优化他们的临终关怀。
