학술논문
Elements of End-of-Life Discussions Associated With Patients' Reported Outcomes and Actual End-of-Life Care in Patients With Pretreated Lung Cancer.
Document Type
Academic Journal
Author
Hasegawa T; Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Aichi, Japan.; Okuyama T; Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Aichi, Japan.; Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.; Department of Psychiatry/Palliative Care Center, Nagoya City University West Medical Center, Nagoya, Aichi, Japan.; Uemura T; Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.; Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan.; Matsuda Y; Department of Psychosomatic Internal Medicine, National Hospital Organization, Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan.; Otani H; Department of Palliative Care Team, Palliative and Supportive Care, National Hospital Organization Kyushu Cancer Center, Fukuoka, Fukuoka, Japan.; Department of Palliative Care Team, Palliative and Supportive Care, St. Mary's Hospital, Kurume, Fukuoka, Japan.; Shimizu J; Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan.; Horio Y; Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan.; Watanabe N; Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan.; Yamaguchi T; Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan.; Fukuda S; Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.; Oguri T; Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.; Department of Education and Research Center for Community Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.; Maeno K; Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.; Taniguchi Y; Department of Internal Medicine, National Hospital Organization, Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan.; Nosaki K; Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Fukuoka, Japan.; Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.; Fukumitsu K; Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.; Akechi T; Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Aichi, Japan.; Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.
Source
Publisher: Oxford University Press Country of Publication: England NLM ID: 9607837 Publication Model: Print Cited Medium: Internet ISSN: 1549-490X (Electronic) Linking ISSN: 10837159 NLM ISO Abbreviation: Oncologist Subsets: MEDLINE
Subject
Language
English
Abstract
Background: End-of-life discussions for patients with advanced cancer are internationally recommended to ensure consistency of end-of-life care with patients' values. This study examined the elements of end-of-life discussions associated with end-of-life care.
Materials and Methods: We performed a prospective observational study among consecutive patients with pretreated non-small cell lung cancer after the failure of first-line chemotherapy. We asked oncologists whether they had ever discussed "prognosis," "do not attempt resuscitation," "hospice," and "preferred place of death" with a patient at baseline. The quality of life (QOL) and depressive symptoms of patients were assessed using validated questionnaires at baseline and 3 months later. The end-of-life care that patients received was investigated using medical records. Oncologists' compassion and caregivers' preferences for hospice care were also assessed using questionnaires. Multiple regression analyses were conducted to examine the association between elements of end-of-life discussions and patient-reported outcomes as well as actual end-of-life care.
Results: We obtained 200 valid responses at baseline, 147 valid responses 3 months later, and 145 data points for medical care at the end-of-life stage. No element of the end-of-life discussion between the patient and their oncologist was significantly associated with patients' reported outcomes or actual end-of-life care. In addition, oncologists' compassion was significantly associated with improvement in both comprehensive QOL and depressive symptoms, and caregivers' preferences for hospice care and high educational level were significantly associated with hospice death.
Conclusion: Oncologist-patient alliances and caregivers' involvement in end-of-life discussions may be influential in achieving optimal end-of-life care.
(© The Author(s) 2023. Published by Oxford University Press.)
Materials and Methods: We performed a prospective observational study among consecutive patients with pretreated non-small cell lung cancer after the failure of first-line chemotherapy. We asked oncologists whether they had ever discussed "prognosis," "do not attempt resuscitation," "hospice," and "preferred place of death" with a patient at baseline. The quality of life (QOL) and depressive symptoms of patients were assessed using validated questionnaires at baseline and 3 months later. The end-of-life care that patients received was investigated using medical records. Oncologists' compassion and caregivers' preferences for hospice care were also assessed using questionnaires. Multiple regression analyses were conducted to examine the association between elements of end-of-life discussions and patient-reported outcomes as well as actual end-of-life care.
Results: We obtained 200 valid responses at baseline, 147 valid responses 3 months later, and 145 data points for medical care at the end-of-life stage. No element of the end-of-life discussion between the patient and their oncologist was significantly associated with patients' reported outcomes or actual end-of-life care. In addition, oncologists' compassion was significantly associated with improvement in both comprehensive QOL and depressive symptoms, and caregivers' preferences for hospice care and high educational level were significantly associated with hospice death.
Conclusion: Oncologist-patient alliances and caregivers' involvement in end-of-life discussions may be influential in achieving optimal end-of-life care.
(© The Author(s) 2023. Published by Oxford University Press.)