Nurse-in-charge, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Professor, Rory Meyers College of Nursing and NYU Aging Incubator, New York University, New York, NY.
Semin Oncol Nurs. 2024 Oct;40(5):151697. doi: 10.1016/j.soncn.2024.151697. Epub 2024 Aug 3.
Concordance of preferences for end-of-life care regarding patients between patients with advanced cancer and family caregivers can improve the likelihood of honoring dying patients' wishes. However, there is a dearth of knowledge in mainland China. The purpose of this study was to examine patient-family caregiver concordance about patients' life-sustaining treatment preferences and associated factors among patients with advanced cancer in China.
From September 2019 to December 2021, a convenience sample of 406 dyads of advanced cancer patient-family caregiver were recruited from 2 tertiary hospitals in Wuhan, China. Participants completed a questionnaire about patient's preferences for life-sustaining treatment, respectively. The concordance was assessed by percent agreement and kappa coefficients. Associated factors were identified by univariate analysis and binary logistic regression.
The average concordance rate on the preferences for life-sustaining treatment was 56.1%, ranging from 52.9% to 59.3%. Factors associated with a higher level of patient-family caregiver concordance were following: patients who were married, whose educational levels were at college or above, who had not been informed of diagnosis by a physician, who had been informed of the effects and side effects of related drugs by a physician, and who cared for a seriously ill family member or friend and caregivers whose educational level were primary or below.
The patient-family caregiver concordance about patients' life-sustaining treatment preferences among patients with advanced cancer was poor. Patients' and caregivers' understanding of life-sustaining treatment and its efficacy in end-of-life should be facilitated. Relevant conversation should be encouraged between patients and caregivers, thus providing value-concordant end-of-life care for patients with cancer.
Health professionals need to carry out advanced care planning in oncology departments on mainland China to encourage patients and caregivers to discuss patients' end-of-life care preferences. Facilitating patients' and caregivers' understanding of life-sustaining treatment preferences may help improve the patient-caregiver concordance on life-sustaining treatment preferences among patients with advanced cancer.
在中国大陆，晚期癌症患者及其家属对临终关怀的偏好一致性可以提高尊重临终患者意愿的可能性。然而，目前这方面的知识还很匮乏。本研究旨在调查中国晚期癌症患者及其家属对患者维持生命治疗偏好的一致性及其相关因素。
本研究于 2019 年 9 月至 2021 年 12 月，采用便利抽样法选取了中国武汉 2 家三级医院的 406 对晚期癌症患者及其家属。患者及其家属分别完成了一份关于患者维持生命治疗偏好的问卷。通过百分比一致性和 Kappa 系数评估一致性。采用单因素分析和二元逻辑回归确定相关因素。
在维持生命治疗偏好方面，平均一致性率为 56.1%，范围为 52.9%至 59.3%。与患者-家属一致性水平较高相关的因素包括：已婚患者、文化程度为大专及以上、未被告知诊断、被告知相关药物的作用和副作用、照顾重病家属或朋友、文化程度为小学及以下的照顾者。
晚期癌症患者及其家属对患者维持生命治疗偏好的一致性较差。应促进患者和照顾者对维持生命治疗及其在临终关怀中的作用的理解。应鼓励患者和照顾者之间进行相关对话，从而为癌症患者提供价值观一致的临终关怀。
中国的卫生专业人员需要在肿瘤科开展高级关怀计划，以鼓励患者和照顾者讨论患者的临终关怀偏好。促进患者和照顾者对维持生命治疗偏好的理解可能有助于提高晚期癌症患者对维持生命治疗偏好的一致性。
