近來(lái),，刊登在Ann Intern Med雜志上的一項(xiàng)研究表明：雖然大部分肺癌患者或是結(jié)直腸癌患者會(huì)與他們的主治醫(yī)生討論對(duì)臨終治療方法的選擇,，但這一討論往往直到癌癥病情發(fā)展到晚期才真正進(jìn)行,。
早期研究表明,，癌癥患者與醫(yī)生討論完臨終治療方法后,，往往更傾向于選擇一種緩和舒適的治療手段進(jìn)行治療，而不太愿意選擇侵入性的治療方法如手術(shù)開(kāi)展治療,，但這些早期研究并未將癌癥患者與醫(yī)生之間的討論發(fā)生的時(shí)機(jī),、地點(diǎn)和對(duì)象納入研究,。
這篇論文的研究者發(fā)現(xiàn)：癌癥患者與醫(yī)生之間遲來(lái)的談話(huà)往往發(fā)生在一種特別緊張的情況下發(fā)生如癌癥患者入院接受搶救時(shí)。并且與癌癥患者開(kāi)展這種討論（臨終治療談話(huà)）的對(duì)象往往是醫(yī)院里的其他醫(yī)生而并不給癌癥患者進(jìn)行治療的腫瘤科醫(yī)生,。
這項(xiàng)研究共納入了2,155名肺癌IV期患者或是結(jié)直腸癌晚期患者,，研究人員根據(jù)臨床病歷記錄對(duì)癌癥患者本人或是陪床人員進(jìn)行采訪(fǎng)，結(jié)果發(fā)現(xiàn)73%的癌癥患者曾經(jīng)與醫(yī)生就關(guān)于臨終治療手段進(jìn)行過(guò)討論,。工作人員通過(guò)對(duì)1,000名已去世的癌癥患者病歷記錄（這些癌癥病歷記錄中都記載了患者與醫(yī)生進(jìn)行過(guò)臨終治療的討論）,，結(jié)果發(fā)現(xiàn)這些談?wù)摪l(fā)生的中位時(shí)間大部分位于癌癥死亡的前33天；55%的論地點(diǎn)在醫(yī)院里,；與癌癥患者進(jìn)行討論的對(duì)象僅有27%為腫瘤科醫(yī)生,。
研究人員表示：討論發(fā)生的地點(diǎn)（醫(yī)院）往往會(huì)剝奪癌癥患者深思熟慮的機(jī)會(huì)，醫(yī)院環(huán)境往往會(huì)給患者帶來(lái)緊張的氣氛,，并且這一討論時(shí)間越長(zhǎng)對(duì)患者越不利,。
研究者強(qiáng)調(diào)：為了癌癥晚期患者利益出發(fā)，有關(guān)臨終治療方法的討論應(yīng)盡早進(jìn)行,，并且地點(diǎn)也應(yīng)該有所選擇,，盡量避免醫(yī)院這種環(huán)境，談?wù)搶?duì)象也應(yīng)盡量選擇自己的臨床主治醫(yī)生,。(生物谷 Bioon.com)
doi:
PMC:
PMID:22312140
End-of-Life Care Discussions Among Patients With Advanced Cancer A Cohort Study
Jennifer W. Mack, MD, MPH; Angel Cronin, MS; Nathan Taback, PhD; Haiden A. Huskamp, PhD; Nancy L. Keating, MD, MPH; Jennifer L. Malin, MD, PhD; Craig C. Earle, MD, MSc; and Jane C. Weeks, MD, MSc
Background: National guidelines recommend that physicians discuss end-of-life (EOL) care planning with patients with cancer whose life expectancy is less than 1 year.
Objective: To evaluate the incidence of EOL care discussions for patients with stage IV lung or colorectal cancer and where, when, and with whom these discussions take place.
Design: Prospective cohort study of patients diagnosed with lung or colorectal cancer from 2003 to 2005.
Setting: Participants lived in Northern California, Los Angeles County, North Carolina, Iowa, or Alabama or received care in 1 of 5 large HMOs or 1 of 15 Veterans Health Administration sites.
Patients: 2155 patients with stage IV lung or colorectal cancer.
Measurements: End-of-life care discussions reported in patient and surrogate interviews or documented in medical records through 15 months after diagnosis.
Results: 73% of patients had EOL care discussions identified by at least 1 source. Among the 1470 patients who died during follow-up, 87% had EOL care discussions, compared with 41% of the 685 patients who were alive at the end of follow-up. Of the 1081 first EOL care discussions documented in records, 55% occurred in the hospital. Oncologists documented EOL care discussions with only 27% of their patients. Among 959 patients with documented EOL care discussions who died during follow-up, discussions took place a median of 33 days before death.
Limitations: The depth and quality of EOL care discussions was not evaluated. Much of the information about discussions came from surrogates of patients who died before baseline interviews could be obtained.
Conclusion: Although most patients with stage IV lung or colorectal cancer discuss EOL care planning with physicians before death, many discussions occur during acute hospital care, with providers other than oncologists, and late in the course of illness.
