在生命末期的晚期癌症患者中，感知到的人际支持与护理攻击性之间的关联。
Associations between perceived interpersonal support and aggressiveness of care in the last month of life among patients with advanced cancer.
机构信息
Department of Medicine, Weill Cornell Medicine, 420 E. 70th Street, New York, NY, USA.
Cornell Center for Research On End-of-Life Care, 420 E. 70th Street, New York, NY, USA.
出版信息
Support Care Cancer. 2024 Sep 24;32(10):682. doi: 10.1007/s00520-024-08892-7.
PURPOSE
To determine quality of life (QoL) domains in the months leading up to death associated with the receipt of aggressive care in the last month of life among patients with advanced cancer.
METHODS
A multisite, prospective cohort study conducted from January 2010 to May 2015 of 59 patients with advanced cancer (distant metastases and/or progression of disease following at least first-line chemotherapy) and poor prognosis (≤ 6 months) followed through death. At baseline, a median of 4 months from death, the McGill Quality of Life Questionnaire measured overall QoL and four QoL domains (i.e., interpersonal support, physical well-being, psychological, and existential). Postmortem data were collected via medical chart review and nurse/caregiver report and combined to capture the aggressiveness of end-of-life (EoL) care in patients' last month of life. Aggressive EoL care was defined as any receipt of care in an intensive care unit, being on a ventilator, or chemotherapy in the last month of life.
RESULTS
Patients with higher interpersonal support domain scores (i.e., rating the world as more "caring and responsive" to their needs and their felt support as more complete) received significantly less aggressive care in their last month of life (odds ratio = 0.39, 95% confidence interval 0.20 to 0.75, p = 0.004).
CONCLUSION
Perceived interpersonal support is the only QoL domain assessed that was associated with aggressiveness of care in the last month of life for patients with advanced cancer. Prioritizing caring and responsive relationships for patients may decrease receipt of aggressive EoL care.
目的
确定在生命最后一个月接受积极治疗的晚期癌症患者在生命最后几个月与接受积极治疗相关的生活质量（QoL）领域。
方法
这是一项从 2010 年 1 月至 2015 年 5 月进行的多地点、前瞻性队列研究，共纳入 59 例晚期癌症（远处转移和/或至少一线化疗后疾病进展）和预后不良（≤6 个月）的患者，并进行了死亡随访。在基线时，即距离死亡中位数为 4 个月时，采用 McGill 生活质量问卷测量总体生活质量和四个生活质量领域（即人际关系支持、身体舒适度、心理和存在）。通过病历回顾和护士/护理人员报告收集死后数据，并将其结合起来，以捕捉患者生命最后一个月的临终关怀的积极程度。临终关怀的积极程度定义为在生命的最后一个月内接受重症监护、使用呼吸机或化疗。
结果
人际支持领域得分较高的患者（即，对世界的评价是更“关心和响应”他们的需求，他们感受到的支持更加完整），在生命的最后一个月接受的积极治疗显著较少（比值比=0.39，95%置信区间 0.20 至 0.75，p=0.004）。
结论
评估的人际关系支持是唯一与晚期癌症患者生命最后一个月接受的治疗积极程度相关的生活质量领域。优先考虑关心和响应的关系可能会减少接受积极的临终关怀。
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