Prospective study of health status preferences and changes in preferences over time in older adults
Prospective study of health status preferences and changes in preferences over time in older adults
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DOI：
10.1001/archinte.166.8.890
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发表时间：
2006-04-24
影响因子：
--
通讯作者：
Dubin, JA
中科院分区：
文献类型：
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作者：
Fried, TR;Byers, AL;Dubin, JA
背景：预先护理计划的指导形式取决于患者预测其未来治疗偏好的能力。然而，偏好可能会随着患者健康状况的变化而改变。方法：我们对226名患有晚期癌症、充血性心力衰竭或慢性阻塞性肺病的老年社区居民进行了至少每4个月一次的家庭访谈，持续时间长达2年。患者被要求对他们的疾病进行评估，如果治疗导致4种健康状态中的1种，那么治疗是否可以接受。结果：被评为可接受的治疗导致轻度（优势比[OR]， 1.11； 95%可信区间[CI]， 1.06-1.16）或严重（OR, 1.06; 95% CI, 1.03-1.09）功能残疾的可能性随着参与的每个月而增加。经历日常生活工具活动能力下降的患者更有可能被评为可接受的治疗，导致轻度（OR, 1.23; 95% CI, 1.08-1.40）或重度（OR, 1.23; 95% CI, 1.11-1.37）残疾。尽管将治疗结果评定为可接受的疼痛状态的总体可能性没有随着时间的推移而改变（OR, 0.98; 95% CI, 0.96-1.01），但与没有中度至重度疼痛的患者相比，中度至重度疼痛的患者更有可能将这种治疗评定为可接受的（OR, 2.55; 95% CI, 1.56-4.19）。结论：对于一些患者来说，随着时间的推移，导致某些健康状况下降的治疗的可接受性增加，而在同一领域经历下降的患者中，可接受性增加的可能性更大。这些变化对提前护理计划提出了挑战，这要求患者预测他们未来的治疗偏好。
Background: Instructional forms of advance care planning depend on the ability of patients to predict their future treatment preferences. However, preferences may change with changes in patients' health states.Methods: We conducted in-home interviews of 226 older community-dwelling persons with advanced cancer, congestive heart failure, or chronic obstructive pulmonary disease at least every 4 months for up to 2 years. Patients were asked to rate whether treatment for their illness would be acceptable if it resulted in 1 of 4 health states.Results: The likelihood of rating as acceptable a treatment resulting in mild (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.06-1.16) or severe (OR, 1.06; 95% CI, 1.03-1.09) functional disability increased with each month of participation. Patients who experienced a decline in their ability to perform instrumental activities of daily living were more likely to rate as acceptable treatment resulting in mild (OR, 1.23; 95% CI, 1.08-1.40) or severe (OR, 1.23; 95% CI, 1.11-1.37) disability. Although the overall likelihood of rating treatment resulting in a state of pain as acceptable did not change over time (OR, 0.98; 95% CI, 0.96-1.01), patients who had moderate to severe pain were more likely to rate this treatment as acceptable (OR, 2.55; 95% CI, 1.56-4.19) than were those who did not have moderate to severe pain.Conclusions: For some patients, the acceptability of treatment resulting in certain diminished states of health increases with time, and increased acceptability is more likely among patients experiencing a decline in that same domain. These changes pose a challenge to advance care planning, which asks patients to predict their future treatment preferences.