Understanding the treatment preferences of seriously ill patients
Understanding the treatment preferences of seriously ill patients
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DOI：
10.1056/nejmsa012528
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发表时间：
2002-04-04
影响因子：
158.5
通讯作者：
Allore, H
中科院分区：
文献类型：
--
作者：
Fried, TR;Bradley, EH;Allore, H
背景：被问及患者对维持生命治疗的偏好的问题通常集中在特定的干预措施上，但治疗的结果及其可能性会影响患者的偏好。方法：我们对226名因癌症、充血性心力衰竭或慢性阻塞性肺疾病而预期寿命有限的60岁及以上的患者进行了治疗偏好问卷调查。研究参与者被问及是否想要接受给定的治疗，首先是在确定结果的情况下，然后是不同的不良结果可能性。结果：治疗的负担(即住院时间、检测范围和干预措施的侵入性)、结果以及结果的可能性都会影响治疗偏好。对于目前健康恢复的低负担治疗，98.7%的参与者表示他们会选择接受治疗(而不是不接受并死亡)，但如果负担很高，11.2%的参与者不会选择治疗。如果结果是生存，但有严重的功能障碍或认知障碍，这些参与者中分别有74.4%和88.8%的人不会选择治疗。随着不良结果的可能性增加，表示他们会选择治疗的参与者数量下降，当可能的结果是功能或认知障碍时，选择治疗的参与者比死亡时更少。结论：提前护理计划应考虑患者对治疗负担的态度、可能的结果以及他们的可能性。治疗的不良功能和认知结果的可能性需要明确考虑。
Background: The questions patients are asked about their preferences with regard to life-sustaining treatment usually focus on specific interventions, but the outcomes of treatment and their likelihood affect patients' preferences.Methods: We administered a questionnaire about treatment preferences to 226 persons who were 60 years of age or older and who had a limited life expectancy due to cancer, congestive heart failure, or chronic obstructive pulmonary disease. The study participants were asked whether they would want to receive a given treatment, first when the outcome was known with certainty and then with different likelihoods of an adverse outcome. The outcome without treatment was specified as death from the underlying disease.Results: The burden of treatment (i.e., the length of the hospital stay, extent of testing, and invasiveness of interventions), the outcome, and the likelihood of the outcome all influenced treatment preferences. For a low-burden treatment with the restoration of current health, 98.7 percent of participants said they would choose to receive the treatment (rather than not receive it and die), but 11.2 percent of these participants would not choose the treatment if it had a high burden. If the outcome was survival but with severe functional impairment or cognitive impairment, 74.4 percent and 88.8 percent of these participants, respectively, would not choose treatment. The number of participants who said they would choose treatment declined as the likelihood of an adverse outcome increased, with fewer participants choosing treatment when the possible outcome was functional or cognitive impairment than when it was death. Preferences did not differ according to the primary diagnosis.Conclusions: Advance care planning should take into account patients' attitudes toward the burden of treatment, the possible outcomes, and their likelihood. The likelihood of adverse functional and cognitive outcomes of treatment requires explicit consideration.