癌症病人預後告知的現況及其影響的探討

Prognostic Disclosure and Its Influence on Cancer Patients

陳貞秀(Chen-Hsiu Chen) ； 唐秀治(Siew-Tzuh Tang)

《台灣癌症醫學雜誌》 1卷2期 (2014/09) Pp. 103-112

https://doi.org/10.6323/JCRP.2014.1.2.02

摘要

背景：告知疾病預後是對病人自主權的尊重，惟有病人知道自己的疾病預後，才能主動參與病情討論、做出最符合個人意願及利益的抉擇。然而目前極少研究以統合分析方式指出預後告知的比例及描述預後告知對癌症病人的影響。研究方法：本研究以系統性回顧方式，搜尋癌症病人預後認知相關文獻，並運用統合分析計算預後訊息喜好及預後告知的比例。結果：統合25篇與癌症病人預後訊息喜好及預後告知相關研究，結果顯示大多數的癌症病人表示希望獲得自己病情相關的訊息〔84.6%, 95%信賴區間（CI）74.1%-91.4%）〕，但僅半數的癌症病人實際由醫師告知疾病預後（49.3%, 95% CI 36.4%-62.3%）。當癌症病人希望得知疾病預後而未被告知時，可能對病人造成的影響包括：不當的預後認知、不適切的生命終期照顧目標及照顧模式的選擇、無法作死亡的準備、心理及情緒的困擾等多方面影響。然而醫師可能因正確預估預後的困難、為了維持病人的希望感、缺乏溝通技巧及不知道病人對預後訊息的喜好等，造成病人期望知道與真實被告知預後之差距。結論：為了縮短病人期望知道與真實被告知預後之差距，醫護人員應採取適當的措施以克服醫師面對預後告知的困境，使癌症末期病人在了解疾病預後下，有機會做出與自己願望一致的臨終決定，接受符合其需求的醫療照顧，以達到改善癌症末期病人照顧品質的目標。

關鍵字

預後告知 ； 預後認知 ； 癌症病人

並列摘要

Background: Prognostic disclosure is a show of respect for patient autonomy. Only patients who are aware of their prognosis can participate in discussions about their medical condition and make decisions that meet their individual preferences. Despite the abundant literature on this topic, no systematic estimates of prognostic disclosure in cancer patients are available and relatively little research has focused on the impact of prognostic awareness and disclosure on cancer patients. Methods: The literature on prognostic awareness and disclosure in cancer patients was systematically reviewed and subjected to a meta-analysis. Results: The literature search retrieved 25 articles for meta-analysis. The pooled proportion of preferences for prognostic information and prognostic disclosure was calculated. Most cancer patients expressed a preference for prognostic disclosure [84.6%, 95% confidence interval (CI) 74.1%-91.4%)], but only about half were told their prognosis (49.3%, 95% CI 36.4%-62.3%). These results indicate a gap between cancer patients’ preferences for prognostic disclosure and their actual receipt of prognosis. Cancer patients who are not told their prognosis may have several negative consequences, including inappropriate prognostic awareness, receiving futile treatment at the end of life, being unprepared for death, increased psychological and mental distress as well as social and spiritual suffering, and decreased quality of life. The discrepancy between patients' preferred and actual prognostic disclosure is primarily due to physicians' difficulty in revealing the prognosis; this difficulty stems from inaccurate estimates of prognosis, attitudes of beneficence and maintaining patients' hope, lack of good communication skills, and not knowing patients' preferences for prognostic information. Conclusions: In order to close the gap between patients' preferences for prognostic disclosure and actual receipt of prognostic information, healthcare professionals should develop interventions to overcome the physicians' difficulty in revealing prognosis, thus facilitating cancer patients' awareness of prognosis and providing high quality end-of-life care.

並列關鍵字

prognostic disclosure ； prognostic awareness ； cancer