Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Aichi, Japan.
Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.
Oncologist. 2024 Feb 2;29(2):e282-e289. doi: 10.1093/oncolo/oyad245.
End-of-life discussions for patients with advanced cancer are internationally recommended to ensure consistency of end-of-life care with patients' values. This study examined the elements of end-of-life discussions associated with end-of-life care.
We performed a prospective observational study among consecutive patients with pretreated non-small cell lung cancer after the failure of first-line chemotherapy. We asked oncologists whether they had ever discussed "prognosis," "do not attempt resuscitation," "hospice," and "preferred place of death" with a patient at baseline. The quality of life (QOL) and depressive symptoms of patients were assessed using validated questionnaires at baseline and 3 months later. The end-of-life care that patients received was investigated using medical records. Oncologists' compassion and caregivers' preferences for hospice care were also assessed using questionnaires. Multiple regression analyses were conducted to examine the association between elements of end-of-life discussions and patient-reported outcomes as well as actual end-of-life care.
We obtained 200 valid responses at baseline, 147 valid responses 3 months later, and 145 data points for medical care at the end-of-life stage. No element of the end-of-life discussion between the patient and their oncologist was significantly associated with patients' reported outcomes or actual end-of-life care. In addition, oncologists' compassion was significantly associated with improvement in both comprehensive QOL and depressive symptoms, and caregivers' preferences for hospice care and high educational level were significantly associated with hospice death.
Oncologist-patient alliances and caregivers' involvement in end-of-life discussions may be influential in achieving optimal end-of-life care.
国际上建议对晚期癌症患者进行临终讨论，以确保临终关怀与患者的价值观保持一致。本研究旨在探讨与临终关怀相关的临终讨论内容。
我们对一线化疗失败后接受过预处理的非小细胞肺癌患者进行了前瞻性观察性研究。我们询问了肿瘤医生，在基线时他们是否与患者讨论过“预后”、“不进行心肺复苏”、“临终关怀”和“首选死亡地点”。在基线和 3 个月后，使用经过验证的问卷评估患者的生活质量（QOL）和抑郁症状。通过病历调查了患者接受的临终关怀。还使用问卷评估了肿瘤医生的同情心和照护者对临终关怀的偏好。进行了多元回归分析，以探讨临终讨论内容与患者报告的结果以及实际临终关怀之间的关联。
我们在基线时获得了 200 份有效回复，在 3 个月后获得了 147 份有效回复，在临终关怀阶段获得了 145 个医疗数据点。患者与肿瘤医生之间的临终讨论内容与患者报告的结果或实际临终关怀均无显著关联。此外，肿瘤医生的同情心与综合 QOL 和抑郁症状的改善显著相关，照护者对临终关怀的偏好和高教育水平与 Hospice 死亡显著相关。
肿瘤医生-患者联盟和照护者参与临终讨论可能对实现最佳临终关怀具有重要影响。
