Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Oncologist. 2024 Nov 4;29(11):e1586-e1592. doi: 10.1093/oncolo/oyae159.
Given the typical trajectory of glioblastoma, many patients lose decision-making capacity over time, which can lead to inadequate advance care planning (ACP) and end-of-life (EOL) care. We aimed to evaluate patients' current ACP and EOL care status.
We conducted a cohort study on 205 patients referred to oncologists at a Korean tertiary hospital between 2017 and 2022. We collected information on sociodemographic factors, cancer treatment, palliative care consultation, ACP, legal documents on life-sustaining treatment (LST) decisions, and aggressiveness of EOL care.
With a median follow-up time of 18.3 months: 159 patients died; median overall survival: 20.3 months. Of the 159 patients, 11 (6.9%) and 63 (39.6%) had advance directive (AD) and LST plans, respectively, whereas 85 (53.5%) had neither. Among the 63 with LST plans, 10 (15.9%) and 53 (84.1%) completed their forms through self-determination and family determination, respectively. Of the 159 patients who died, 102 (64.2%) received palliative care consultation (median time: 44 days from the first consultation to death) and 78 (49.1%) received aggressive EOL care. Those receiving palliative care consultations were less likely to receive aggressive EOL care (83.3% vs 32.4%, P < .001), and more likely to use more than 3 days of hospice care at EOL (19.6% vs 68.0%, P < .001).
The right to self-determination remains poorly protected among patients with glioblastoma, with nearly 90% not self-completing AD or LST plan. As palliative care consultation is associated with less aggressive EOL care and longer use of hospice care, physicians should promptly introduce patients to ACP conversations and palliative care consultations.
鉴于胶质母细胞瘤的典型病程，许多患者随着时间的推移逐渐丧失决策能力，这可能导致不足的预先护理计划（ACP）和临终关怀。我们旨在评估患者当前的 ACP 和临终关怀状况。
我们对 2017 年至 2022 年间在韩国一家三级医院就诊的 205 名肿瘤科医生进行了一项队列研究。我们收集了社会人口学因素、癌症治疗、姑息治疗咨询、ACP、关于生命支持治疗（LST）决策的法律文件以及临终关怀的攻击性的信息。
中位随访时间为 18.3 个月：159 名患者死亡；中位总生存期：20.3 个月。在 159 名患者中，11 名（6.9%）和 63 名（39.6%）分别有预先指示（AD）和 LST 计划，而 85 名（53.5%）两者均无。在有 LST 计划的 63 名患者中，10 名（15.9%）和 53 名（84.1%）分别通过自我决定和家庭决定完成了表格。在 159 名死亡患者中，102 名（64.2%）接受了姑息治疗咨询（从第一次咨询到死亡的中位时间为 44 天），78 名（49.1%）接受了积极的临终关怀。接受姑息治疗咨询的患者不太可能接受积极的临终关怀（83.3%比 32.4%，P<0.001），更有可能在临终关怀时使用超过 3 天的临终关怀（19.6%比 68.0%，P<0.001）。
在胶质母细胞瘤患者中，自我决定的权利仍然得不到很好的保护，近 90%的患者没有自行完成 AD 或 LST 计划。由于姑息治疗咨询与较少的临终关怀和更长时间的临终关怀使用有关，医生应及时向患者介绍 ACP 对话和姑息治疗咨询。
