PDF(Pubmed)
Abstract：
BACKGROUND: Symptom burdens tend to increase for patients with cancer and their families over the disease trajectory. There is still a lack of evidence on the associations between symptom changes and the quality of dying and death. In this context, this research investigated how symptom changes influence the quality of dying and death.
METHODS: This international prospective cohort study (the East Asian Collaborative Cross-Cultural Study to Elucidate the Dying Process (EASED), 2017-2019) included 22, 11, and 4 palliative care units across Japan, South Korea, and Taiwan. Eligible participants were adults (Japan and Korea, ≥18 years; Taiwan, ≥20 years) with locally advanced or metastatic cancer. Physical and psychological symptoms were assessed by physicians upon admission and within 3 days before death. Death quality was assessed using the Good Death Scale (GDS), developed in Taiwan. Univariate and multivariate regression analyses were used to identify correlations between symptom severity changes and GDS scores.
RESULTS: Among 998 patients (542 [54.3%] men and 456 [45.7%] women; mean [SD] age = 70.1 [± 12.5] years), persistent dyspnea was associated with lower GDS scores when compared to stable dyspnea (β = -0.427, 95% CI = -0.783 to -0.071). Worsened (-1.381, -1.932 to -0.831) and persistent (-1.680, -2.701 to -0.659) delirium were also significantly associated with lower GDS scores.
CONCLUSIONS: Better quality of dying and death was associated with improved symptom control, especially for dyspnea and delirium. Integrating an outcome measurement for the quality of dying and death is important in the management of symptoms across the disease trajectory in a goal-concordant manner.
METHODS: This international prospective cohort study (the East Asian Collaborative Cross-Cultural Study to Elucidate the Dying Process (EASED), 2017-2019) included 22, 11, and 4 palliative care units across Japan, South Korea, and Taiwan. Eligible participants were adults (Japan and Korea, ≥18 years; Taiwan, ≥20 years) with locally advanced or metastatic cancer. Physical and psychological symptoms were assessed by physicians upon admission and within 3 days before death. Death quality was assessed using the Good Death Scale (GDS), developed in Taiwan. Univariate and multivariate regression analyses were used to identify correlations between symptom severity changes and GDS scores.
RESULTS: Among 998 patients (542 [54.3%] men and 456 [45.7%] women; mean [SD] age = 70.1 [± 12.5] years), persistent dyspnea was associated with lower GDS scores when compared to stable dyspnea (β = -0.427, 95% CI = -0.783 to -0.071). Worsened (-1.381, -1.932 to -0.831) and persistent (-1.680, -2.701 to -0.659) delirium were also significantly associated with lower GDS scores.
CONCLUSIONS: Better quality of dying and death was associated with improved symptom control, especially for dyspnea and delirium. Integrating an outcome measurement for the quality of dying and death is important in the management of symptoms across the disease trajectory in a goal-concordant manner.
摘要：
背景：癌症患者及其家人在疾病轨迹上的症状负担往往会增加。仍然缺乏关于症状变化与死亡和死亡质量之间关联的证据。在这种情况下，这项研究调查了症状变化如何影响死亡和死亡的质量。
方法：这项国际前瞻性队列研究（东亚合作跨文化研究，以阐明死亡过程（EASED），2017-2019)包括日本的22、11和4个姑息治疗单位，韩国,和台湾。符合条件的参与者是成年人(日本和韩国，≥18岁；台湾，≥20年）患有局部晚期或转移性癌症。入院时和死亡前3天内由医生评估身体和心理症状。使用良好死亡量表(GDS)评估死亡质量，在台湾发展。使用单变量和多变量回归分析来确定症状严重程度变化与GDS评分之间的相关性。
结果：在998例患者中（男性542例[54.3%]，女性456例[45.7%]；平均年龄[SD]=70.1[±12.5]岁），与稳定型呼吸困难相比,持续性呼吸困难与较低的GDS评分相关(β=-0.427,95%CI=-0.783~-0.071).加重（-1.381，-1.932至-0.831）和持续性（-1.680，-2.701至-0.659）谵妄也与较低的GDS评分显着相关。
结论：更好的死亡和死亡质量与改善症状控制有关。尤其是呼吸困难和谵妄。整合死亡和死亡质量的结果测量对于以目标一致的方式管理整个疾病轨迹的症状非常重要。
方法：这项国际前瞻性队列研究（东亚合作跨文化研究，以阐明死亡过程（EASED），2017-2019)包括日本的22、11和4个姑息治疗单位，韩国,和台湾。符合条件的参与者是成年人(日本和韩国，≥18岁；台湾，≥20年）患有局部晚期或转移性癌症。入院时和死亡前3天内由医生评估身体和心理症状。使用良好死亡量表(GDS)评估死亡质量，在台湾发展。使用单变量和多变量回归分析来确定症状严重程度变化与GDS评分之间的相关性。
结果：在998例患者中（男性542例[54.3%]，女性456例[45.7%]；平均年龄[SD]=70.1[±12.5]岁），与稳定型呼吸困难相比,持续性呼吸困难与较低的GDS评分相关(β=-0.427,95%CI=-0.783~-0.071).加重（-1.381，-1.932至-0.831）和持续性（-1.680，-2.701至-0.659）谵妄也与较低的GDS评分显着相关。
结论：更好的死亡和死亡质量与改善症状控制有关。尤其是呼吸困难和谵妄。整合死亡和死亡质量的结果测量对于以目标一致的方式管理整个疾病轨迹的症状非常重要。
