Brown D, Roberts J A, Elkins T E, Larson D, Hopkins M
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor 48109.
Gynecol Oncol. 1994 Dec;55(3 Pt 1):355-62. doi: 10.1006/gyno.1994.1306.
Few reports in gynecologic literature have addressed patient preferences about terminal care. In light of the current discussions about end-of-life decision-making, a study was designed to assess the desires of patients with gynecologic cancer. A questionnaire was completed by 108 patients under treatment for gynecologic cancer at the University of Michigan Medical Center and by 39 patients from the routine gynecology clinic at the same institution. Participants were asked about their reactions to a poor prognosis, their desires for the location of terminal care, and their preferences for withdrawing or withholding life-sustaining technologies. Five percent of these cancer patients anticipated giving up the fight against their disease. Seventy-eight percent specifically expressed resolve to continue the fight against their disease. Feedback from these patients about their end-of-life preferences served to define the concept "fight." A majority preferred to receive care at home. Ninety percent of these cancer patients could envision their conditions deteriorating to the point that they would not want ventilator support. Thirty-four percent could envision refusing surgery for another life-threatening condition; 37%, a time when artificial nutrition would be refused; 22%, a time when antibiotics would be rejected. This study suggests that limiting the use of artificial respiratory support while continuing the use of artificial nutrition and hydration support would be consistent with the preferences of gynecologic cancer with end-stage disease.
妇科文献中很少有报告涉及患者对临终关怀的偏好。鉴于当前关于临终决策的讨论，一项研究旨在评估妇科癌症患者的愿望。密歇根大学医学中心108名接受妇科癌症治疗的患者以及同一机构常规妇科诊所的39名患者填写了一份问卷。参与者被问及他们对预后不良的反应、对临终关怀地点的愿望以及对撤除或停止维持生命技术的偏好。这些癌症患者中有5%预计会放弃与疾病的抗争。78%的患者明确表示决心继续与疾病作斗争。这些患者关于临终偏好的反馈有助于界定“抗争”这一概念。大多数人更愿意在家中接受护理。这些癌症患者中有90%能够想象自己的病情恶化到不想接受呼吸机支持的程度。34%的人能够想象自己会拒绝接受针对另一种危及生命状况的手术；37%的人能够想象自己会拒绝人工营养支持的时候；22%的人能够想象自己会拒绝使用抗生素的时候。这项研究表明，在继续使用人工营养和补液支持的同时限制使用人工呼吸支持，符合晚期妇科癌症患者的偏好。
