The impact of advance care planning on end of life care in elderly patients: randomised controlled trial.
The impact of advance care planning on end of life care in elderly patients: randomised controlled trial.
复制标题
DOI：
10.1136/bmj.c1345
复制
发表时间：
2010-03-23
期刊：
影响因子：
--
通讯作者：
Silvester W
中科院分区：
文献类型：
--
作者：
Detering KM;Hancock AD;Reade MC;Silvester W
目的探讨提前护理计划对老年患者临终关怀的影响。设计前瞻性随机对照试验。在澳大利亚墨尔本的一所大学医院进行单中心研究。参与者是309名年龄在80岁或以上的合法住院病人，随访6个月或直至死亡。干预措施参与者被随机分配接受常规护理或常规护理加辅助提前护理计划。预先的护理计划旨在帮助病人反思他们的目标、价值观和信仰；考虑未来的医疗选择；指定代理人：指定代理人；并记录他们的愿望。主要结局指标主要结局指标是患者的临终愿望是否得到了解和尊重。其他结果包括患者和家属对住院的满意度以及死亡患者亲属的压力、焦虑和抑郁水平。结果309例患者中有154例被随机分配到预先护理计划组，125例（81%）接受了预先护理计划，108例（84%）表达了意愿或指定了代理人，或两者兼有。在56例6个月死亡的患者中，干预组（25/ 29,86%）比对照组（8/ 27,30%；P<0.001）更有可能了解和遵循临终愿望。干预组死亡患者家属的压力（干预5，对照15，P<0.001）、焦虑（干预0，对照3，P=0.02）、抑郁（干预0，对照5，P=0.002）均显著低于对照组。干预组患者及家属满意度较高。结论：提前制定护理计划可改善临终关怀，提高患者和家属满意度，减少在世亲属的压力、焦虑和抑郁。澳大利亚新西兰临床试验注册ACTRN12608000539336。
Objective To investigate the impact of advance care planning on end of life care in elderly patients. Design Prospective randomised controlled trial. Setting Single centre study in a university hospital in Melbourne, Australia. Participants 309 legally competent medical inpatients aged 80 or more and followed for six months or until death. Interventions Participants were randomised to receive usual care or usual care plus facilitated advance care planning. Advance care planning aimed to assist patients to reflect on their goals, values, and beliefs; to consider future medical treatment preferences; to appoint a surrogate; and to document their wishes. Main outcome measures The primary outcome was whether a patient’s end of life wishes were known and respected. Other outcomes included patient and family satisfaction with hospital stay and levels of stress, anxiety, and depression in relatives of patients who died. Results 154 of the 309 patients were randomised to advance care planning, 125 (81%) received advance care planning, and 108 (84%) expressed wishes or appointed a surrogate, or both. Of the 56 patients who died by six months, end of life wishes were much more likely to be known and followed in the intervention group (25/29, 86%) compared with the control group (8/27, 30%; P<0.001). In the intervention group, family members of patients who died had significantly less stress (intervention 5, control 15; P<0.001), anxiety (intervention 0, control 3; P=0.02), and depression (intervention 0, control 5; P=0.002) than those of the control patients. Patient and family satisfaction was higher in the intervention group. Conclusions Advance care planning improves end of life care and patient and family satisfaction and reduces stress, anxiety, and depression in surviving relatives. Trial registration Australian New Zealand clinical trials registry ACTRN12608000539336.
登录
查看更多内容
影响因子：
2.8
作者：
Keay, Timothy J;Alexander, Carla;Eger, Ruth E
通讯作者：
Eger, Ruth E
影响因子：
2.8
作者：
Schwartz, Carolyn;Lennes, Inga;Ma, Yunsheng
通讯作者：
Ma, Yunsheng
影响因子：
--
作者：
MORRISON, RS;MORRISON, EW;GLICKMAN, DF
通讯作者：
GLICKMAN, DF
影响因子：
--
作者：
Hammes, BJ;Rooney, BL
通讯作者：
Rooney, BL
影响因子：
2.8
作者：
Briggs, Linda
通讯作者：
Briggs, Linda