Nakazawa Yoko, Miyashita Mitsunori, Morita Tatsuya, Kizawa Yoshiyuki, Okumura Yasuyuki, Kawagoe Shohei, Yamamoto Hiroshi, Takeuchi Emi, Yamazaki Risa, Ogawa Asao
Division of Policy Evaluation, Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Support Care Cancer. 2025 Aug 8;33(9):768. doi: 10.1007/s00520-025-09776-0.
End-of-life (EOL) discussions are integral to EOL care. However, whether EOL discussions improve the concordance between care preferences and care received, and their association with a good death, remains uncertain. This study aimed to examine the association among EOL discussions, concordance with patient preferences for EOL care, and family-reported good deaths in patients with cancer.
This observational study analyzed 42,379 responses from national mortality follow-back survey targeting bereaved families of patients. Measurements included EOL discussions regarding resuscitation preferences (i.e., code status) and care settings, advance directives (ADs), concordance between patient preferences and received care, and family-reported good-death scores.
EOL discussions between patients and physicians increased the concordance for resuscitation preferences and care settings. Concordance for do-not-attempt resuscitation (DNAR) order increased (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.46-2.06), as did full code (OR, 2.75; 95% CI, 2.03-3.74). Regarding care settings, preferred home care showed the highest concordance (OR, 4.60; 95% CI, 4.31-4.90). ADs were associated with concordance for full code preferences (OR, 1.63; 95% CI, 1.17-2.28) but not for DNAR. Preference concordance was associated with higher family-reported "good death" scores, with the largest difference observed for home care (71.4 vs. 60.2; difference, 11.2; 95% CI, 10.9-11.5).
EOL discussions enhanced preference-concordant care for resuscitation preferences and care settings, which were associated with better family-reported good deaths. These findings underscore the importance of integrating EOL discussions into routine oncology care to ensure high-quality EOL care that is consistent with patient preferences.
临终讨论是临终关怀的重要组成部分。然而，临终讨论是否能提高护理偏好与所接受护理之间的一致性，以及它们与善终的关联，仍不明确。本研究旨在探讨临终讨论、与患者临终护理偏好的一致性以及癌症患者家属报告的善终情况之间的关联。
这项观察性研究分析了针对患者丧亲家庭的全国死亡率随访调查中的42379份回复。测量内容包括关于复苏偏好（即代码状态）和护理场所的临终讨论、预先指示（ADs）、患者偏好与所接受护理之间的一致性，以及家属报告的善终评分。
患者与医生之间的临终讨论提高了复苏偏好和护理场所的一致性。不尝试复苏（DNAR）医嘱的一致性增加（优势比[OR]，1.73；95%置信区间[CI]，1.46 - 2.06），完全复苏（OR，2.75；95%CI，2.03 - 3.74）也是如此。关于护理场所，首选的居家护理显示出最高的一致性（OR，4.60；95%CI，4.31 - 4.90）。预先指示与完全复苏偏好的一致性相关（OR，1.63；95%CI，1.17 - 2.28），但与DNAR无关。偏好一致性与家属报告的较高“善终”评分相关，居家护理观察到的差异最大（71.4对60.2；差异，11.2；95%CI，10.9 - 11.5）。
临终讨论增强了在复苏偏好和护理场所方面与偏好一致的护理，这与家属报告的更好的善终情况相关。这些发现强调了将临终讨论纳入常规肿瘤护理以确保与患者偏好一致的高质量临终护理的重要性。
