PDF(Pubmed)
Abstract：
BACKGROUND: In Colombia, cancer incidence is increasing, as is the demand for end-of-life care. Understanding how patients who die from cancer experience this phase will allow the identification of factors associated with greater suffering and actions to improve end-of-life care. We aimed to explore associations between the level of suffering of patients who died from cancer and were cared for in three Colombian hospitals with patient, tumor, treatment, and care characteristics and provided information.
METHODS: Data on the last week of life and level of suffering were collected through proxies: Bereaved caregivers of patients who died from cancer in three participating Colombian hospitals. Bereaved caregivers participated in a phone interview and answered a series of questions regarding the last week of the patient\'s life. An ordinal logistic regression model explored the relationship between the level of suffering reported by bereaved caregivers with the patient\'s demographic and clinical characteristics, the bereaved caregivers, and the care received. Multivariate analyses were adjusted for place of death, treatments to prolong of life, prolongation of life during the dying process, suffering due to prolongation of life, type of cancer, age, if patient had partner, rural/urban residence of patient, importance of religion for the caregiver, caregivers´ relationship with the patient, and co-living with the patient.
RESULTS: A total of 174 interviews were included. Median age of the deceased patients was 64 years (IQR 52-72 years), and 93 patients were women (53.4%). Most caregivers had rated the level of suffering of their relative as \"moderately to extremely\" (n = 139, 80%). In multivariate analyses, factors associated with a higher level of suffering were: unclear information about the treatment and the process before death Odds Ratio (OR) 2.26 (90% CI 1.21-4.19), outpatient palliative care versus home care OR 3.05 (90% CI 1.05-8.88), procedures inconsistent with the patient\'s wishes OR 2.92 (90% CI 1.28-6.70), and a younger age (18-44 years) at death versus the oldest age group (75-93 years) OR 3.80 (90% CI 1.33-10.84, p = 0.04).
CONCLUSIONS: End-of-life care for cancer patients should be aligned as much as possible with patients´ wishes, needs, and capacities. A better dialogue between doctors, family members, and patients is necessary to achieve this.
METHODS: Data on the last week of life and level of suffering were collected through proxies: Bereaved caregivers of patients who died from cancer in three participating Colombian hospitals. Bereaved caregivers participated in a phone interview and answered a series of questions regarding the last week of the patient\'s life. An ordinal logistic regression model explored the relationship between the level of suffering reported by bereaved caregivers with the patient\'s demographic and clinical characteristics, the bereaved caregivers, and the care received. Multivariate analyses were adjusted for place of death, treatments to prolong of life, prolongation of life during the dying process, suffering due to prolongation of life, type of cancer, age, if patient had partner, rural/urban residence of patient, importance of religion for the caregiver, caregivers´ relationship with the patient, and co-living with the patient.
RESULTS: A total of 174 interviews were included. Median age of the deceased patients was 64 years (IQR 52-72 years), and 93 patients were women (53.4%). Most caregivers had rated the level of suffering of their relative as \"moderately to extremely\" (n = 139, 80%). In multivariate analyses, factors associated with a higher level of suffering were: unclear information about the treatment and the process before death Odds Ratio (OR) 2.26 (90% CI 1.21-4.19), outpatient palliative care versus home care OR 3.05 (90% CI 1.05-8.88), procedures inconsistent with the patient\'s wishes OR 2.92 (90% CI 1.28-6.70), and a younger age (18-44 years) at death versus the oldest age group (75-93 years) OR 3.80 (90% CI 1.33-10.84, p = 0.04).
CONCLUSIONS: End-of-life care for cancer patients should be aligned as much as possible with patients´ wishes, needs, and capacities. A better dialogue between doctors, family members, and patients is necessary to achieve this.
摘要：
背景：在哥伦比亚，癌症发病率正在增加，对临终关怀的需求也是如此。了解死于癌症的患者如何经历这一阶段，将有助于确定与更大痛苦和行动相关的因素，以改善临终关怀。我们旨在探索死于癌症的患者的痛苦水平与在三家哥伦比亚医院接受患者护理之间的关联，肿瘤，治疗,和护理特点，并提供信息。
方法：通过代理人：哥伦比亚三家参与的医院中，死于癌症的患者的失去亲人的照顾者收集了生命的最后一周和痛苦程度的数据。失去亲人的护理人员参加了一次电话采访，并回答了一系列关于患者生命最后一周的问题。有序logistic回归模型探讨了失去亲人的照顾者报告的痛苦水平与患者的人口统计学和临床特征之间的关系，失去亲人的照顾者，和得到的照顾。多因素分析对死亡地点进行了调整，延长寿命的治疗方法，在死亡过程中延长生命，由于寿命延长而遭受的痛苦，癌症的类型,年龄,如果病人有伴侣,患者的农村/城市住所，宗教对照顾者的重要性，照顾者与病人的关系,与病人共同生活。
结果：共纳入174次访谈。死亡患者的中位年龄为64岁（IQR52-72岁），93例患者为女性(53.4%)。大多数护理人员将其亲属的痛苦程度评为“中度到极度”（n=139，80％）。在多变量分析中，与较高痛苦水平相关的因素是：关于死亡前治疗和过程的信息不清楚赔率比（OR）2.26（90％CI1.21-4.19），门诊姑息治疗与家庭护理或3.05（90%CI1.05-8.88），与患者意愿不符的程序或2.92（90%CI1.28-6.70），与最老年龄组(75-93岁)相比，死亡年龄较小(18-44岁)或3.80(90%CI1.33-10.84，p=0.04)。
结论：癌症患者的临终关怀应尽可能符合患者的意愿，需要,和能力。医生之间更好的对话，家庭成员,患者是实现这一目标所必需的。
方法：通过代理人：哥伦比亚三家参与的医院中，死于癌症的患者的失去亲人的照顾者收集了生命的最后一周和痛苦程度的数据。失去亲人的护理人员参加了一次电话采访，并回答了一系列关于患者生命最后一周的问题。有序logistic回归模型探讨了失去亲人的照顾者报告的痛苦水平与患者的人口统计学和临床特征之间的关系，失去亲人的照顾者，和得到的照顾。多因素分析对死亡地点进行了调整，延长寿命的治疗方法，在死亡过程中延长生命，由于寿命延长而遭受的痛苦，癌症的类型,年龄,如果病人有伴侣,患者的农村/城市住所，宗教对照顾者的重要性，照顾者与病人的关系,与病人共同生活。
结果：共纳入174次访谈。死亡患者的中位年龄为64岁（IQR52-72岁），93例患者为女性(53.4%)。大多数护理人员将其亲属的痛苦程度评为“中度到极度”（n=139，80％）。在多变量分析中，与较高痛苦水平相关的因素是：关于死亡前治疗和过程的信息不清楚赔率比（OR）2.26（90％CI1.21-4.19），门诊姑息治疗与家庭护理或3.05（90%CI1.05-8.88），与患者意愿不符的程序或2.92（90%CI1.28-6.70），与最老年龄组(75-93岁)相比，死亡年龄较小(18-44岁)或3.80(90%CI1.33-10.84，p=0.04)。
结论：癌症患者的临终关怀应尽可能符合患者的意愿，需要,和能力。医生之间更好的对话，家庭成员,患者是实现这一目标所必需的。
