Determinants of Prognosis Awareness for Advanced Cancer Patients Who were Not under Hospice Care in Taiwan

影響臺灣地區非安寧照顧下進展性癌症病患認知預後的因素

陳貞秀(Chen-Hsiu Chen) ； 劉莉妮(Li-Ni Liu) ； 徐翠霞(Tsui-Hsia Hsu) ； 蔣曉文(Hsiao-Wen Chiang) ； 雷靜怡(Ching-Yi Lei) ； 唐秀治(Siew-Tzuh Tang)

《中華民國癌症醫學會雜誌》 24卷1期 (2008/02) Pp. 49-59

https://doi.org/10.6588/JCOS.2008.24.1.7

摘要

西方國家基於對病人自主權的尊重，倡導病患必須被充分告知疾病的診斷及預後，而近期臺灣地區非安寧照顧下進展性癌症病人的調查亦顯示，不僅病人普遍期待能被告知疾病預後的訊息，且病人「是否認知預後」是控制了病人之年齡、家庭經濟狀況及症狀困擾程度後，影響病患生活品質的重要因素。因此本研究的目的在探討影響臺灣地區非安寧照顧下進展性癌症病人預後認知的因素。
本研究採橫斷性描述性研究，調查二十四家臺灣地區非安寧照顧下，1,108對進展性癌症病患及其家屬對癌症預後的認知、期待被告知、及真實被告知的狀況，並以多變項邏輯式迴歸分析影響病患預後認知之因素。研究結果顯示，42.7%及67.0%的進展性癌症病患及其家屬認知病人疾病的預後，但卻僅有32.7%及60.3%的病患及其家屬指出曾被正確告知病人疾病預後的訊息；影響病患預後認知因素以病人有被醫師正確告知預後(adjusted odds ratio (AOR), 228.5; 95% confidence interval (CI), 100.76-518.35)最為顯著，除此之外，家屬有認知預後(AOR, 5.25; 95% CI: 3.10-8.91)、病患有較強烈意願希望知道預後(AOR, 1.28; 95% CI: 1.10-1.49)、家屬與病人關係為配偶(AOR, 1.60; 95% CI: 1.04-2.45)、病患的症狀困擾程度較嚴重(AOR, 1.03; 95% CI: 1.01-1.06)、及較年輕病人(AOR, 0.98; 95% CI: 0.97-1.00)均為增加進展性癌症病患「認知預後」之重要因素。由於影響病患預後認知關鍵因素仍在於病患有無被告知預後，因此醫護人員應瞭解告知病患預後對其病情認知及對未來醫療決策與生活品質的重要性，提供符合病患期待之預後訊息，以維護病患自主權利與提昇生活品質。

關鍵字

預後認知 ； 預後告知 ； 進展性癌症病人 ； 臨終照顧

並列摘要

Background: In Western cultural, based on the respect for patient autonomy, it is highly recommended that patients shall be informed of their diagnosis and prognosis. Recent surveys indicated that not only Taiwanese advanced cancer patients' information needs were substantial but also that after controlling for the effects of age, financial status, and symptom distress, patient awareness of prognosis had a significant impact on patients' quality of life. Therefore, the purpose of this study was to investigate the determinants of prognosis awareness for advanced cancer patients who were not under hospice care in Taiwan.
Methods: 1108 dyads of patient-family caregiver from 24 hospitals throughout Taiwan were one-time surveyed. The determinants of prognosis awareness were identified by multivariate logistic regression analysis.
Results: 42.7% and 67.0% of the patients and their family caregivers indicated that they knew of the patient's prognosis, respectively. However, only 32.7% and 60.3% of the patients and their family caregivers had ever been informed by their physicians of the patient's prognosis, respectively. Disclosure of prognosis by the physician had the strongest direct effect on the patient's awareness of prognosis (adjusted odds ratio (AOR), 228.5; 95% confidence interval (CI), 100.76-518.35), followed by family caregiver's awareness of prognosis (AOR, 5.25; 95% CI: 3.10-8.91), the extent of patient preference of being informed of prognosis (AOR, 1.28; 95% CI: 1.10-1.49), spousal relationship between the patient and his/her family caregiver (AOR, 1.60; 95% CI: 1.04-2.45), the degree of symptom distress (AOR, 1.03; 95% CI: 1.01-1.06), and the
age of the patient (AOR, 0.98; 95% CI: 0.97-1.00).
Conclusions: The odds of the patient's awareness of prognosis were increased enormously if the patient was told about her/his prognosis. Health care professionals shall honor the information preference for those who wish to know about their prognosis. Equipped with and empowered by adequate information, advanced cancer patients may have better opportunities to make end-of-life care decisions that are in accord with their own wishes.

並列關鍵字

Awareness of prognosis ； Prognosis disclosure ； advanced cancer patients ； end-of-life care