临床时讯 ＞ 临床研究
近来，刊登在《内科学报》（Annals of Internal Medicine）杂志上的一项研究表明：虽然大部分肺癌患者或是结直肠癌患者会与他们的主治医生讨论对临终治疗方法的选择，但这一讨论往往直到癌症病情发展到晚期才真正进行。
Ann Intern Med. 2012 Feb 7;156(3):204-10.
End-of-Life Care Discussions Among Patients With Advanced Cancer: A Cohort Study.
Mack JW, Cronin A, Taback N, Huskamp HA, Keating NL, Malin JL, Earle CC, Weeks JC.
Dana-Farber Cancer Institute, Children's Hospital, Harvard Medical School, and Brigham and Women's Hospital, Boston, Massachusetts; Veterans Affairs Greater Los Angeles Healthcare System and University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, California; and Ontario Institute for Cancer Research, Toronto, Ontario, Canada.
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. Primary Funding Source: National Cancer Institute and Department of Veterans Affairs.