Understanding End-of-Life Preferences: Predicting Life-Prolonging Treatment Preferences Among Community-Dwelling Older Americans.
Understanding End-of-Life Preferences: Predicting Life-Prolonging Treatment Preferences Among Community-Dwelling Older Americans.
复制标题
了解临终偏好：预测社区居住的美国老年人的延长生命治疗偏好。
DOI：
10.1016/j.jpainsymman.2020.04.010
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发表时间：
2020
影响因子：
4.7
通讯作者：
Burke,JamesF
中科院分区：
文献类型：
--
作者：
Brenner,AllisonB;Skolarus,LesliE;Perumalswami,ChithraR;Burke,JamesF
目的 确定人口、社会经济、健康和心理社会因素如何预测生命末期 (EOL) 时接受延长生命治疗 (LPT) 的偏好。方法这是一项针对居住在社区的美国老年人全国代表性样本 (N= 1648) 的回顾性队列研究。接受 LPT 的定义是，在 EOL 发生严重残疾或严重慢性疼痛的假设事件中希望接受所有 LPT。拥有持久授权书、生前遗嘱或与家人讨论过 EOL 的参与者决心表达他们的 EOL 偏好。主要分析使用调查加权逻辑回归来衡量老年人特征与 LPT 接受度之间的关联。其次，使用回归模型测量 LPT 偏好与健康结果之间的关联。结果大约 31% 的老年人会接受 LPT。非白人种族/民族（比值比 [OR] 0.54；95% CI 0.41, 0.70；白人与非白人）、自我实现（OR 1.34；95% CI 1.01, 1.79）、参加宗教仪式（OR 1.44；95% CI 1.07, 1.94）以及偏好表达（OR 0.54；95% CI 1.07, 1.94）。 95% CI (0.40, 0.72) 与接受 LPT 相关。 LPT 偏好与死亡率或残疾并不独立相关。结论 大约三分之一的美国老年人在 EOL 出现严重残疾或严重慢性疼痛的情况下会接受 LPT。讨论过 EOL 偏好的成年人更有可能拒绝 LPT。相反，少数族裔更有可能接受 LPT。社会人口统计学、身体能力和健康状况是接受 LPT 的不良预测因素。更好地了解 LPT 偏好的复杂性对于确保以患者为中心的护理非常重要。
ObjectivesTo determine how demographic, socioeconomic, health, and psychosocial factors predict preferences to accept life-prolonging treatments (LPTs) at the end of life (EOL).MethodsThis is a retrospective cohort study of a nationally representative sample of community-dwelling older Americans (N= 1648). Acceptance of LPT was defined as wanting to receive all LPTs in the hypothetical event of severe disability or severe chronic pain at the EOL. Participants with a durable power of attorney, living will, or who discussed EOL with family were determined to have expressed their EOL preferences. The primary analysis used survey-weighted logistic regression to measure the association between older adult characteristics and acceptance of LPT. Secondarily, the associations between LPT preferences and health outcomes were measured using regression models.ResultsApproximately 31% of older adults would accept LPT. Nonwhite race/ethnicity (odds ratio [OR] 0.54; 95% CI 0.41, 0.70; white vs. nonwhite), self-realization (OR 1.34; 95% CI 1.01, 1.79), attendance of religious services (OR 1.44; 95% CI 1.07, 1.94), and expression of preferences (OR 0.54; 95% CI 0.40, 0.72) were associated with acceptance of LPT. LPT preferences were not independently associated with mortality or disability.ConclusionsApproximately one-third of older Americans would accept LPT in the setting of severe disability or severe chronic pain at the EOL. Adults who discussed their EOL preferences were more likely to reject LPT. Conversely, minorities were more likely to accept LPT. Sociodemographics, physical capacity, and health status were poor predictors of acceptance of LPT. A better understanding of the complexities of LPT preferences is important to ensuring patient-centered care.