Department of Behavioral Science, College of Medicine, University of Kentucky, 760 Press Avenue, 467 Healthy Kentucky Research Building, Lexington, KY, 40536, USA.
Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA.
Support Care Cancer. 2023 Feb 27;31(3):190. doi: 10.1007/s00520-023-07649-y.
Despite clinical guidelines, palliative care is underutilized during advanced stage lung cancer treatment. To inform interventions to increase its use, patient-level barriers and facilitators (i.e., determinants) need to be characterized, especially among patients living in rural areas or those receiving treatment outside academic medical centers.
Between 2020 and 2021, advanced stage lung cancer patients (n = 77; 62% rural; 58% receiving care in the community) completed a one-time survey assessing palliative care use and its determinants. Univariate and bivariate analyses described palliative care use and determinants and compared scores by patient demographic (e.g., rural vs. urban) and treatment setting (e.g., community vs. academic medical center) factors.
Roughly half said they had never met with a palliative care doctor (49.4%) or nurse (58.4%) as part of cancer care. Only 18% said they knew what palliative care was and could explain it; 17% thought it was the same as hospice. After palliative care was distinguished from hospice, the most frequently cited reasons patients stated they would not seek palliative care were uncertainty about what it would offer (65%), concerns about insurance coverage (63%), difficulty attending multiple appointments (60%), and lack of discussion with an oncologist (59%). The most common reasons patients stated they would seek palliative care were a desire to control pain (62%), oncologist recommendation (58%), and coping support for family and friends (55%).
Interventions should address knowledge and misconceptions, assess care needs, and facilitate communication between patients and oncologists about palliative care.
尽管有临床指南，但在晚期肺癌治疗中，姑息治疗的应用仍不充分。为了提出干预措施以增加其使用，需要对患者层面的障碍和促进因素（即决定因素）进行描述，特别是在居住在农村地区或在学术医疗中心之外接受治疗的患者中。
在 2020 年至 2021 年间，77 名晚期肺癌患者（62%来自农村，58%在社区接受治疗）完成了一项一次性调查，评估姑息治疗的使用情况及其决定因素。单变量和双变量分析描述了姑息治疗的使用和决定因素，并按患者人口统计学（如农村与城市）和治疗环境（如社区与学术医疗中心）因素比较了分数。
大约一半的患者表示，他们从未在癌症治疗中见过姑息治疗医生（49.4%）或护士（58.4%）。只有 18%的患者表示他们知道姑息治疗是什么，并能解释它；17%的人认为它与临终关怀相同。将姑息治疗与临终关怀区分开后，患者表示他们不会寻求姑息治疗的最常见原因是对其提供的服务不确定（65%）、担心保险覆盖范围（63%）、难以参加多次预约（60%）以及与肿瘤医生缺乏讨论（59%）。患者表示他们会寻求姑息治疗的最常见原因是渴望控制疼痛（62%）、肿瘤医生的建议（58%）和为家人和朋友提供应对支持（55%）。
干预措施应针对知识和误解、评估护理需求以及促进患者和肿瘤医生之间关于姑息治疗的沟通。
