近来，刊登在Ann Intern Med杂志上的一项研究表明：虽然大部分肺癌患者或是结直肠癌患者会与他们的主治医生讨论对临终治疗方法的选择，但这一讨论往往直到癌症病情发展到晚期才真正进行。
早期研究表明，癌症患者与医生讨论完临终治疗方法后，往往更倾向于选择一种缓和舒适的治疗手段进行治疗，而不太愿意选择侵入性的治疗方法如手术开展治疗，但这些早期研究并未将癌症患者与医生之间的讨论发生的时机、地点和对象纳入研究。
这篇论文的研究者发现：癌症患者与医生之间迟来的谈话往往发生在一种特别紧张的情况下发生如癌症患者入院接受抢救时。并且与癌症患者开展这种讨论（临终治疗谈话）的对象往往是医院里的其他医生而并不给癌症患者进行治疗的肿瘤科医生。
这项研究共纳入了2,155名肺癌IV期患者或是结直肠癌晚期患者，研究人员根据临床病历记录对癌症患者本人或是陪床人员进行采访，结果发现73%的癌症患者曾经与医生就关于临终治疗手段进行过讨论。工作人员通过对1,000名已去世的癌症患者病历记录（这些癌症病历记录中都记载了患者与医生进行过临终治疗的讨论），结果发现这些谈论发生的中位时间大部分位于癌症死亡的前33天；55%的论地点在医院里；与癌症患者进行讨论的对象仅有27%为肿瘤科医生。
研究人员表示：讨论发生的地点（医院）往往会剥夺癌症患者深思熟虑的机会，医院环境往往会给患者带来紧张的气氛，并且这一讨论时间越长对患者越不利。
研究者强调：为了癌症晚期患者利益出发，有关临终治疗方法的讨论应尽早进行，并且地点也应该有所选择，尽量避免医院这种环境，谈论对象也应尽量选择自己的临床主治医生。(生物谷 Bioon.com)
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PMID:22312140
End-of-Life Care Discussions Among Patients With Advanced Cancer A Cohort Study
Jennifer W. Mack, MD, MPH; Angel Cronin, MS; Nathan Taback, PhD; Haiden A. Huskamp, PhD; Nancy L. Keating, MD, MPH; Jennifer L. Malin, MD, PhD; Craig C. Earle, MD, MSc; and Jane C. Weeks, MD, MSc
Background: National guidelines recommend that physicians discuss end-of-life (EOL) care planning with patients with cancer whose life expectancy is less than 1 year.
Objective: To evaluate the incidence of EOL care discussions for patients with stage IV lung or colorectal cancer and where, when, and with whom these discussions take place.
Design: Prospective cohort study of patients diagnosed with lung or colorectal cancer from 2003 to 2005.
Setting: Participants lived in Northern California, Los Angeles County, North Carolina, Iowa, or Alabama or received care in 1 of 5 large HMOs or 1 of 15 Veterans Health Administration sites.
Patients: 2155 patients with stage IV lung or colorectal cancer.
Measurements: End-of-life care discussions reported in patient and surrogate interviews or documented in medical records through 15 months after diagnosis.
Results: 73% of patients had EOL care discussions identified by at least 1 source. Among the 1470 patients who died during follow-up, 87% had EOL care discussions, compared with 41% of the 685 patients who were alive at the end of follow-up. Of the 1081 first EOL care discussions documented in records, 55% occurred in the hospital. Oncologists documented EOL care discussions with only 27% of their patients. Among 959 patients with documented EOL care discussions who died during follow-up, discussions took place a median of 33 days before death.
Limitations: The depth and quality of EOL care discussions was not evaluated. Much of the information about discussions came from surrogates of patients who died before baseline interviews could be obtained.
Conclusion: Although most patients with stage IV lung or colorectal cancer discuss EOL care planning with physicians before death, many discussions occur during acute hospital care, with providers other than oncologists, and late in the course of illness.
