Introduction: The life experience of patients with advanced cancer and limited life expectancy is unique and profoundly complex, often leading to moral discrepancies among the various individuals involved in decision making. There are no data in the literature on the prevalence of ethical issues in the end-of-life care of patients with advanced cancer. Objectives: The primary objective of this study is to identify the overall and specific prevalence of ethical issues in the end-of-life care process for patients with advanced cancer. Method: We performed a secondary analysis using pooled data from the prospective development and validation cohorts of the PALCOM scale, focusing on the complexity of palliative care needs. This was performed to determine the overall and specific prevalence of ethical issues, describe their evolution over a 6-month follow-up period, and analyze their association with the level of palliative care complexity. Results: A total of 607 patients with advanced cancer and a life expectancy of 6 months or less were included. The consistency in clinical data and the frequencies of the PALCOM scale domains between the development and validation cohorts, conducted in various settings and times, confirmed the reliability of the pooled data sample. Systematic application of the PALCOM scale identified 126 patients (20.7%) who experienced at least one ethical issue. A total of 204 ethical issues (1.6 per patient) were recorded, related to the following: the proportionality of healthcare intervention (15.6%); information (13.0%); research (2.9%); the desire to hasten death (1.8%); and palliative sedation (0.15%). The monthly probability of presenting an ethical issue was significantly higher at the baseline visit (24.0%) compared to the rest of the 6-month follow-up period (14–17%) (p< 0.001). The prevalence of ethical issues was notably higher in patients with greater palliative care complexity as measured by the PALCOM scale: 4.5% in low complexity, 19.5% in medium complexity, and 30.8% in high complexity (p< 0.001). Conclusions: The prevalence of ethical issues in patients with advanced cancer is high. Most of these issues are directly or indirectly related to the preservation of patient autonomy in the decision-making process. The presence of ethical issues is significantly associated with the greater complexity of palliative care needs. In this context, it is crucial for healthcare professionals to strengthen both communication skills and basic competencies to effectively identify, assess, and manage these ethical issues.
引言：晚期癌症且预期寿命有限的患者，其生命体验具有独特性且极为复杂，常导致参与决策的各方产生伦理认知差异。目前文献中尚无关于晚期癌症患者临终关怀过程中伦理问题发生率的系统数据。本研究旨在明确晚期癌症患者临终关怀过程中伦理问题的总体发生率及具体分布特征。方法：我们采用PALCOM量表（姑息照护复杂性评估工具）前瞻性开发与验证队列的合并数据进行二次分析，聚焦姑息照护需求复杂性，以确定伦理问题的总体与具体发生率，描述其在6个月随访期内的演变规律，并分析其与姑息照护复杂性程度的相关性。结果：共纳入607例预期生存期≤6个月的晚期癌症患者。在不同场景与时间开展的开发队列与验证队列中，临床数据的一致性及PALCOM量表各维度频率的稳定性证实了合并数据样本的可靠性。通过系统应用PALCOM量表，识别出126例（20.7%）患者至少经历一项伦理问题。共记录204项伦理问题（人均1.6项），涉及以下维度：医疗干预的适度性（15.6%）、信息告知（13.0%）、临床研究（2.9%）、加速死亡意愿（1.8%）以及姑息镇静（0.15%）。基线访视时出现伦理问题的月概率（24.0%）显著高于后续6个月随访期（14-17%）（p<0.001）。根据PALCOM量表评估，姑息照护复杂性更高的患者中伦理问题发生率显著升高：低复杂性组4.5%，中复杂性组19.5%，高复杂性组30.8%（p<0.001）。结论：晚期癌症患者伦理问题发生率较高，其中多数问题与决策过程中患者自主权的维护直接或间接相关。伦理问题的存在与姑息照护需求的更高复杂性显著关联。在此背景下，医疗专业人员亟需加强沟通技能与核心能力建设，以有效识别、评估和处理这些伦理问题。
肿瘤(癌症)患者之家