Supporting the Heterogeneous and Evolving Treatment Preferences of Patients With Heart Failure Through Collaborative Home-Based Palliative Care.
Supporting the Heterogeneous and Evolving Treatment Preferences of Patients With Heart Failure Through Collaborative Home-Based Palliative Care.
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DOI：
10.1161/jaha.122.026319
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发表时间：
2022-10-04
影响因子：
5.4
通讯作者：
Quinn, Kieran L.
中科院分区：
文献类型：
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作者：
Campos, Erin;Isenberg, Sarina R.;Lovblom, Leif Erik;Mak, Susanna;Steinberg, Leah;Bush, Shirley H.;Goldman, Russell;Graham, Cassandra;Kavalieratos, Dio;Stukel, Therese;Tanuseputro, Peter;Quinn, Kieran L.
我们描述了由协作式家庭姑息治疗模式支持的晚期心力衰竭患者的治疗偏好、护理环境和临终结局。这项死亡队列研究纳入了250例晚期心力衰竭患者，这些患者于2013年4月至2019年7月在加拿大安大略接受协作式家庭姑息治疗，中位随访时间为1.9个月。根据患者的初始治疗偏好，将其分为4组之一。结果包括死亡地点（院外与院内）、治疗偏好的变化和卫生服务的使用。在最初优先考虑生活质量的患者中，21/43（48.8%）在随访期间改变了他们的治疗偏好（平均每月0.28次变化）。这些患者中的大多数改变了他们的偏好，以避免住院治疗，并专注于家中的舒适度（24个变化中的19个，79%）。250例患者中共有207例（82.8%）发生院外死亡。与最初优先考虑家庭生活质量的患者相比，最初优先考虑生活质量的患者的院外死亡几率降低（与院内死亡相比;调整后的比值比为0.259 [95% CI，0.097-0.693]），住院频率更高（平均每人每月住院0.45次）。我们的研究结果产生了更详细的了解先进的护理计划和病人的喜好的相互作用。个性化治疗的共同决策是动态的，可以在生命结束之前制定。
We characterized the treatment preferences, care setting, and end‐of‐life outcomes among patients with advanced heart failure supported by a collaborative home‐based model of palliative care. This decedent cohort study included 250 patients with advanced heart failure who received collaborative home‐based palliative care for a median duration of 1.9 months of follow‐up in Ontario, Canada, from April 2013 to July 2019. Patients were categorized into 1 of 4 groups according to their initial treatment preferences. Outcomes included location of death (out of hospital versus in hospital), changes in treatment preferences, and health service use. Among patients who initially prioritized quantity of life, 21 of 43 (48.8%) changed their treatment preferences during follow‐up (mean 0.28 changes per month). The majority of these patients changed their preferences to avoid hospitalization and focus on comfort at home (19 of 24 changes, 79%). A total of 207 of 250 (82.8%) patients experienced an out‐of‐hospital death. Patients who initially prioritized quantity of life had decreased odds of out‐of‐hospital death (versus in‐hospital death; adjusted odds ratio, 0.259 [95% CI, 0.097–0.693]) and more frequent hospitalizations (mean 0.45 hospitalizations per person‐month) compared with patients who initially prioritized quality of life at home. Our results yield a more detailed understanding of the interaction of advanced care planning and patient preferences. Shared decision making for personalized treatment is dynamic and can be enacted earlier than at the very end of life.