Graduate School of Education, Tohoku University, Sendai, Miyagi, Japan.
Graduate School of Human Science, Osaka University, Suita, Osaka, Japan.
Jpn J Clin Oncol. 2024 Jul 7;54(7):787-796. doi: 10.1093/jjco/hyae038.
This study aimed to clarify the situation and evaluate the communication on anticancer treatment discontinuation from the viewpoint of a bereaved family, in reference to the concept of nudges.
A multi-center questionnaire survey was conducted involving 350 bereaved families of patients with cancer admitted to palliative care units in Japan.
The following explanations were rated as essential or very useful: (i) treatment would be a physical burden to the patient (42.9%), (ii) providing anticancer treatment was impossible (40.5%), (iii) specific disadvantages of receiving treatment (40.5%), (iv) not receiving treatment would be better for the patient (39.9%) and (v) specific advantages of not receiving treatment (39.6%). The factors associated with a high need for improvement of the physician's explanation included lack of explanation on specific advantages of not receiving treatment (β = 0.228, P = 0.001), and lack of explanation of 'If the patient's condition improves, you may consider receiving the treatment again at that time.' (β = 0.189, P = 0.008).
Explaining the disadvantages of receiving treatment and the advantages of not receiving treatment, and presenting treatment discontinuation as the default option were effective in helping patients' families in making the decision to discontinue treatment. In particular, explanation regarding specific advantages of not receiving treatment was considered useful, as they caused a lower need for improvement of the physicians' explanation.
本研究旨在参照“助推”的概念，从丧亲家庭的角度阐明并评估有关癌症治疗终止的沟通情况。
对日本姑息治疗病房收治的 350 名癌症患者的丧亲家属进行了一项多中心问卷调查。
以下解释被认为是必要的或非常有用的：（i）治疗会给患者带来身体负担（42.9%），（ii）提供抗癌治疗是不可能的（40.5%），（iii）接受治疗的具体弊端（40.5%），（iv）不接受治疗对患者更好（39.9%），（v）不接受治疗的具体优势（39.6%）。与医生解释需要改进的高度相关的因素包括缺乏不接受治疗的具体优势的解释（β=0.228，P=0.001），以及缺乏“如果患者病情改善，您可以考虑届时再次接受治疗”的解释（β=0.189，P=0.008）。
解释接受治疗的弊端和不接受治疗的优势，并将治疗终止作为默认选项，有助于患者家属做出终止治疗的决定。特别是，不接受治疗的具体优势的解释被认为是有用的，因为它们降低了医生解释需要改进的程度。
