一份关于姑息治疗阶段个体化预后咨询的研究方案。

A study protocol for individualized prognostic counselling in the palliative phase.

作者信息

van den Besselaar Boyd Noël, Sewnaik A, Dorr M C, Hoesseini A, Hardillo J A, Baatenburg de Jong R J, Offerman M P J

机构信息

Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands.

出版信息

BMC Palliat Care. 2025 Jan 10;24(1):9. doi: 10.1186/s12904-025-01647-z.

DOI:10.1186/s12904-025-01647-z

PMID:39794711

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11720302/

Abstract

BACKGROUND

Head and neck squamous cell cancer (HNSCC) has a poor prognosis, with approximately 25-30% of patients transitioning into the palliative phase at some point. The length of this phase is relatively short, with a median duration of five months. Patients in this stage often have increased prognostic information needs. Unfortunately, predicting individual life expectancy in this phase is particularly challenging, as physicians and patients tend to overestimate survival. To address this issue, we developed the prognostic model OncologIQ Palliative based on user preferences. In this study, we now aim to assess the clinical impact of utilizing this model during counselling.

METHODS

This study will employ both quantitative and qualitative approaches. The primary outcome is decisional conflict and satisfaction with the decision-making process after counselling without (cohort 1) and with (cohort 2) OncologIQ Palliative. Therefore, a prospective sequential cohort study will be conducted. Secondary outcomes include the amount of palliative treatment, overall survival rates, and quality of life. These measurements will be collected after the intervention. Additionally, patients' perspectives on the decision-making process and proactive care planning, including end-of-life discussions, will be explored through interviews.

DISCUSSION

By offering more personalized prognostic information for HNSCC patients in the palliative phase, we anticipate a shift towards more patient-centred counselling. This approach can facilitate enhanced end-of-life discussions and better proactive care planning. Patients may experience reduced decisional conflict, feel better prepared for what's coming, and find assistance in their decision-making process. This could potentially lead to fewer palliative treatments. Overall, these aspects can contribute to a better quality of life and quality of care for HNSCC patients in the last phase of their lives.

TRIAL REGISTRATION

This study was registered November 18, 2024, on ClinicalTrials.gov: NCT06699316.

摘要

背景

头颈部鳞状细胞癌（HNSCC）预后较差，约25%-30%的患者在某个阶段会进入姑息治疗阶段。该阶段持续时间相对较短，中位时长为五个月。处于此阶段的患者通常对预后信息的需求增加。不幸的是，预测此阶段个体的预期寿命极具挑战性，因为医生和患者往往会高估生存期。为解决这一问题，我们基于用户偏好开发了预后模型OncologIQ Palliative。在本研究中，我们旨在评估在咨询过程中使用该模型的临床影响。

方法

本研究将采用定量和定性方法。主要结局是在不使用（队列1）和使用（队列2）OncologIQ Palliative进行咨询后，决策冲突和对决策过程的满意度。因此，将进行一项前瞻性序贯队列研究。次要结局包括姑息治疗的数量、总生存率和生活质量。这些测量将在干预后收集。此外，将通过访谈探索患者对决策过程和积极护理计划（包括临终讨论）的看法。

讨论

通过为处于姑息治疗阶段的HNSCC患者提供更个性化的预后信息，我们预计将转向以患者为中心的咨询方式。这种方法可以促进加强临终讨论和更好的积极护理计划。患者可能会减少决策冲突，对即将到来的事情有更好的准备，并在决策过程中获得帮助。这可能会减少姑息治疗的使用。总体而言，这些方面有助于提高HNSCC患者生命最后阶段的生活质量和护理质量。