THE IMPACT OF SERIOUS ILLNESS ON PATIENTS FAMILIES
THE IMPACT OF SERIOUS ILLNESS ON PATIENTS FAMILIES
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DOI：
10.1001/jama.272.23.1839
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发表时间：
1994-12-21
影响因子：
120.7
通讯作者：
PHILLIPS, RS
中科院分区：
文献类型：
--
作者：
COVINSKY, KE;GOLDMAN, L;PHILLIPS, RS
客观。-检查疾病对重病成年人家庭的影响，并确定不利经济影响的相关因素。数据是在研究期间收集的，以了解预后和偏好的结果和治疗风险（支持），一项前瞻性队列研究的结果，偏好，并在重病住院成人及其家人的决策。美国的五家三级医院。2661名在9个诊断类别中存活的指数住院并出院回家的重病患者符合此分析的条件，这些患者中有2129名（80%）获得了关于疾病对家庭影响的代理人和/或患者访谈（平均年龄，62岁; 43%女性; 6个月生存率，75%）。对代孕母亲和患者进行调查，以确定不良生育和经济负担的频率，进行多变量分析，以确定家庭储蓄损失的相关性。三分之一（34%）的患者需要家庭成员的大量帮助。在20%的病例中，一名家庭成员不得不辞职或做出另一项重大生活改变来照顾病人。31%的家庭报告失去了大部分或全部家庭储蓄，而29%的家庭报告失去了主要收入来源。在多变量分析中，与家庭储蓄损失独立相关的患者因素包括功能状态差（比值比[OR]，1.40; 95%置信区间[CI]，1.10至1.78，对于需要三种或三种以上日常生活活动帮助的患者），家庭收入较低（年收入低于25 000美元的人OR为1.74; 95%CI为1.37至2.21）和年轻年龄（OR为2.85;与65岁或以上的人相比，45岁以下的人95%CI为2.13至3.82）。许多重病患者的家庭经历了严重的医疗和经济负担。年轻、贫穷和功能依赖性更强的患者的家庭最有可能报告大部分或全部家庭储蓄的损失。
Objective.-To examine the impact of illness on the families of seriously ill adults and to determine the correlates of adverse economic impact.Design.-Data were collected during the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT), a prospective cohort study of outcomes, preferences, and decision making in seriously ill hospitalized adults and their families.Setting.-Five tertiary care hospitals in the United States.Participants.-The 2661 seriously ill patients in nine diagnostic categories who survived their index hospitalization and were discharged home were eligible for this analysis, Surrogate and/or patient interviews about the impact of illness on the family were obtained for 2129 (80%) of these patients (mean age, 62 years; 43% women; 6-month survival, 75%).Outcome Measures.-Surrogates and patients were surveyed to determine the frequency of adverse caregiving and economic burdens, Multivariable analyses were performed to determine correlates of loss of family savings.Results.-One third (34%) of patients required considerable caregiving assistance from a family member. In 20% of cases, a family member had to quit work or make another major life change to provide care for the patient. Loss of most or all of the family savings was reported by 31% of families, whereas 29% reported loss of the major source of income. Patient factors independently associated with loss of the family's savings on multivariable analysis included poor functional status (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.10 to 1.78 for patients needing assistance with three or more activities of daily living), lower family income (OR, 1.74; 95% CI, 1.37 to 2.21 for those with annual incomes below $25 000), and young age (OR, 2.85; 95% CI, 2.13 to 3.82 for those younger than 45 years compared with those 65 years or older).Conclusions.-Many families of seriously ill patients experience severe caregiving and financial burdens. Families of younger, poorer, and more functionally dependent patients are most likely to report loss of most or all of the family's savings.