Associations between perceived interpersonal support and aggressiveness of care in the last month of life among patients with advanced cancer.

IF 2.8 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Supportive Care in Cancer Pub Date : 2024-09-24 DOI:10.1007/s00520-024-08892-7

Madeleine M Hardt, Madison K Pavao, Sosi E Korian, Charlotte D LaPlante, Paul K Maciejewski, Holly G Prigerson

{"title":"Associations between perceived interpersonal support and aggressiveness of care in the last month of life among patients with advanced cancer.","authors":"Madeleine M Hardt, Madison K Pavao, Sosi E Korian, Charlotte D LaPlante, Paul K Maciejewski, Holly G Prigerson","doi":"10.1007/s00520-024-08892-7","DOIUrl":null,"url":null,"abstract":"Purpose: To determine quality of life (QoL) domains in the months leading up to death associated with the receipt of aggressive care in the last month of life among patients with advanced cancer.Methods: A multisite, prospective cohort study conducted from January 2010 to May 2015 of 59 patients with advanced cancer (distant metastases and/or progression of disease following at least first-line chemotherapy) and poor prognosis (≤ 6 months) followed through death. At baseline, a median of 4 months from death, the McGill Quality of Life Questionnaire measured overall QoL and four QoL domains (i.e., interpersonal support, physical well-being, psychological, and existential). Postmortem data were collected via medical chart review and nurse/caregiver report and combined to capture the aggressiveness of end-of-life (EoL) care in patients' last month of life. Aggressive EoL care was defined as any receipt of care in an intensive care unit, being on a ventilator, or chemotherapy in the last month of life.Results: Patients with higher interpersonal support domain scores (i.e., rating the world as more \"caring and responsive\" to their needs and their felt support as more complete) received significantly less aggressive care in their last month of life (odds ratio = 0.39, 95% confidence interval 0.20 to 0.75, p = 0.004).Conclusion: Perceived interpersonal support is the only QoL domain assessed that was associated with aggressiveness of care in the last month of life for patients with advanced cancer. Prioritizing caring and responsive relationships for patients may decrease receipt of aggressive EoL care.","PeriodicalId":22046,"journal":{"name":"Supportive Care in Cancer","volume":null,"pages":null},"PeriodicalIF":2.8000,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466437/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Supportive Care in Cancer","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00520-024-08892-7","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose: To determine quality of life (QoL) domains in the months leading up to death associated with the receipt of aggressive care in the last month of life among patients with advanced cancer.

Methods: A multisite, prospective cohort study conducted from January 2010 to May 2015 of 59 patients with advanced cancer (distant metastases and/or progression of disease following at least first-line chemotherapy) and poor prognosis (≤ 6 months) followed through death. At baseline, a median of 4 months from death, the McGill Quality of Life Questionnaire measured overall QoL and four QoL domains (i.e., interpersonal support, physical well-being, psychological, and existential). Postmortem data were collected via medical chart review and nurse/caregiver report and combined to capture the aggressiveness of end-of-life (EoL) care in patients' last month of life. Aggressive EoL care was defined as any receipt of care in an intensive care unit, being on a ventilator, or chemotherapy in the last month of life.

Results: Patients with higher interpersonal support domain scores (i.e., rating the world as more "caring and responsive" to their needs and their felt support as more complete) received significantly less aggressive care in their last month of life (odds ratio = 0.39, 95% confidence interval 0.20 to 0.75, p = 0.004).

Conclusion: Perceived interpersonal support is the only QoL domain assessed that was associated with aggressiveness of care in the last month of life for patients with advanced cancer. Prioritizing caring and responsive relationships for patients may decrease receipt of aggressive EoL care.

查看原文本刊更多论文

晚期癌症患者在生命最后一个月感知到的人际支持与积极护理之间的关系。

目的：确定晚期癌症患者死亡前几个月的生活质量（QoL）领域与生命最后一个月接受积极治疗的相关性：2010年1月至2015年5月期间，对59名晚期癌症患者（至少一线化疗后出现远处转移和/或疾病进展）进行了多地点前瞻性队列研究，并对预后不良（≤6个月）的患者进行了死亡随访。在中位数为死亡后 4 个月的基线期，麦吉尔生活质量问卷对总体生活质量和四个生活质量领域（即人际支持、身体健康、心理和生存）进行了测量。通过病历审查和护士/护理人员报告收集死后数据，并将这些数据结合起来，以了解患者生命最后一个月的临终关怀（EoL）的积极程度。积极的临终关怀是指患者在生命的最后一个月接受了重症监护室护理、使用呼吸机或化疗：人际支持领域得分较高的患者（即认为世界对他们的需求更 "关心和响应"，以及认为他们得到的支持更全面）在生命的最后一个月得到的积极护理明显较少（几率比 = 0.39，95% 置信区间为 0.20 至 0.75，p = 0.004）：结论：感知到的人际支持是唯一一个与晚期癌症患者生命最后一个月的积极护理相关的 QoL 领域。优先考虑患者的关怀和回应关系可能会减少患者接受积极的生命质量护理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Supportive Care in Cancer 医学-康复医学

CiteScore

5.70

自引率

9.70%

发文量

751

审稿时长

3 months

期刊介绍： Supportive Care in Cancer provides members of the Multinational Association of Supportive Care in Cancer (MASCC) and all other interested individuals, groups and institutions with the most recent scientific and social information on all aspects of supportive care in cancer patients. It covers primarily medical, technical and surgical topics concerning supportive therapy and care which may supplement or substitute basic cancer treatment at all stages of the disease. Nursing, rehabilitative, psychosocial and spiritual issues of support are also included.