Abe Akiko, Takeuchi Mari, Kobayashi Masato, Kohno Takashi, Mimura Masaru, Fujisawa Daisuke
Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
Palliative Care Center, Keio University School of Medicine, Tokyo, Japan.
Palliat Support Care. 2024 Apr;22(2):374-380. doi: 10.1017/S1478951523001396.
Discussing end-of-life (EOL) issues with patients remains challenging for health professionals. Physicians may use various expressions, including euphemistic ones, when disclosing the prognosis to their patients to reduce their psychological impact. However, the actual expressions of EOL disclosure in clinical practice are unclear. This study aims to investigate the expressions used in EOL disclosures and explore their associated factors.
A retrospective chart review was conducted enrolling all the patients who died in a university-affiliated hospital. Expressions used in the EOL disclosure were qualitatively analyzed. The patients' participation rate and length from the discussion to death were investigated.
EOL disclosures were observed in 341 of 358 patients. The expressions used by the physicians were categorized into 4 groups; Group 1: Clear presentation of life expectancy ( = 106; 31.1%), Group 2: Euphemistic presentation of life expectancy ( = 24; 7.0%), Group 3: Presentation of risk of sudden death ( = 147; 43.1%), Group 4: No mention on life expectancy ( = 64; 18.8%). The proportion of male patients was higher in Group 2 (79%) and lower in Group 4 (56%). Patients with cancer accounted for approximately 70% of Groups 1 and 4, but only approximately 30% of Group 3. The patient participation rate was highest in Group4 (84.4%), followed by Group 2 (50.0%). The median time from EOL disclosure to death was longer in Groups 1 and 4 (26 and 29.5 days, respectively), compared to Groups 2 and 3 (18.5 and 16 days, respectively).
A variety of expressions are used in EOL disclosure. Patterns of communication are influenced by patients' gender and type of illness (cancer or noncancer). Euphemisms do not seem to facilitate timely disclosure of life expectancy or patient participation. For health professionals, not only devising the expressions to alleviate their patients' distress when breaking bad news but also considering the communication process and patient background are essential.
与患者讨论临终问题对医疗专业人员来说仍然具有挑战性。医生在向患者披露预后时可能会使用各种表达方式，包括委婉的表达方式，以减轻对患者的心理影响。然而，临床实践中临终披露的实际表达方式尚不清楚。本研究旨在调查临终披露中使用的表达方式，并探讨其相关因素。
对一家大学附属医院所有死亡患者进行回顾性病历审查。对临终披露中使用的表达方式进行定性分析。调查患者的参与率以及从讨论到死亡的时长。
358例患者中有341例进行了临终披露。医生使用的表达方式分为4组；第1组：明确说明预期寿命（n = 106；31.1%），第2组：委婉说明预期寿命（n = 24；7.0%），第3组：说明猝死风险（n = 147；43.1%），第4组：未提及预期寿命（n = 64；18.8%）。第2组男性患者比例较高（79%），第4组较低（56%）。癌症患者在第1组和第4组中约占70%，但在第3组中仅约占30%。第4组患者参与率最高（84.4%），其次是第2组（50.0%）。与第2组和第3组（分别为18.5天和16天）相比，第1组和第4组从临终披露到死亡的中位时间更长（分别为26天和29.5天）。
临终披露中使用了多种表达方式。沟通模式受患者性别和疾病类型（癌症或非癌症）影响。委婉表达似乎无助于及时披露预期寿命或患者参与。对于医疗专业人员来说，不仅要设计减轻患者坏消息困扰的表达方式，还要考虑沟通流程和患者背景，这至关重要。
