Healthcare Proxies of Nursing Home Residents with Advanced Dementia: Decisions They Confront and Their Satisfaction with Decision-Making
Healthcare Proxies of Nursing Home Residents with Advanced Dementia: Decisions They Confront and Their Satisfaction with Decision-Making
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DOI：
10.1111/j.1532-5415.2009.02304.x
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发表时间：
2009-07-01
影响因子：
6.3
通讯作者：
Mitchell, Susan L.
中科院分区：
文献类型：
--
作者：
Givens, Jane L.;Kiely, Dan K.;Mitchell, Susan L.
描述护理之家（NH）居民晚期痴呆患者的医疗保健代理人（HCP）所面临的医疗决策，并确定与更大的决策满意度相关的因素。做出决定后，HCP完成了决策满意度量表（DSI）（范围0-100）。独立变量包括HCP和居民的社会人口学特征、健康状况和提前护理计划。多变量线性回归确定了与较高DSI评分相关的因素（满意度较高）。（38.1%）回忆起至少做过一次医疗决定;作出了232项关于喂养问题的决定（27.2%）、感染（20.7%）、疼痛（12.9%）、呼吸困难（8.2%）、行为问题（6.9%）、住院（3.9%）、癌症（3.0%）和其他并发症（17.2%）。平均DSI评分+/-标准差为78.4 +/- 19.5，表明总体满意度较高。NH供应商参与共同决策是满意度最低的领域。在调整后的分析中，更大的决策满意度与居民生活在一个特殊的照顾痴呆症单位（P=.002），更大的居民舒适度（P=.004），和HCP不是居民的孩子（P=.02）。卫生保健提供者的支持不足是HCP对决策不满的最大来源。更大的居民舒适度和照顾在一个特殊的照顾痴呆症单位是潜在的可修改的因素与更大的决策满意度。
OBJECTIVESTo describe the medical decisions confronting healthcare proxies (HCPs) of nursing home (NH) residents with advanced dementia and to identify factors associated with greater decision-making satisfaction.DESIGNProspective cohort study.SETTINGTwenty-two Boston-area NHs.PARTICIPANTSThree hundred twenty-three NH residents with advanced dementia and their HCPs.MEASUREMENTSDecisions made by HCPs over 18 months were ascertained quarterly. After making a decision, HCPs completed the Decision Satisfaction Inventory (DSI) (range 0-100). Independent variables included HCP and resident sociodemographic characteristics, health status, and advance care planning. Multivariable linear regression identified factors associated with higher DSI scores (greater satisfaction).RESULTSOf 323 HCPs, 123 (38.1%) recalled making at least one medical decision; 232 decisions were made, concerning feeding problems (27.2%), infections (20.7%), pain (12.9%), dyspnea (8.2%), behavior problems (6.9%), hospitalizations (3.9%), cancer (3.0%), and other complications (17.2%). Mean DSI score +/- standard deviation was 78.4 +/- 19.5, indicating high overall satisfaction. NH provider involvement in shared decision-making was the area of least satisfaction. In adjusted analysis, greater decision-making satisfaction was associated with the resident living on a special care dementia unit (P=.002), greater resident comfort (P=.004), and the HCP not being the resident's child (P=.02).CONCLUSIONHCPs of NH patients with advanced dementia can most commonly expect to encounter medical decisions relating to feeding problems, infections, and pain. Inadequate support from NH providers is the greatest source of HCP dissatisfaction with decision-making. Greater resident comfort and care in a special care dementia unit are potentially modifiable factors associated with greater decision-making satisfaction.