What matters to seriously ill older persons making end-of-life treatment decisions?: A qualitative study.
What matters to seriously ill older persons making end-of-life treatment decisions?: A qualitative study.
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DOI：
10.1089/109662103764978489
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发表时间：
2003-04-01
影响因子：
2.8
通讯作者：
Bradley, Elizabeth H
中科院分区：
文献类型：
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作者：
Fried, Terri R;Bradley, Elizabeth H
背景：有几种方法可以引出生命末期治疗偏好。然而，很少有工作已经做了引出从患者自己的治疗决策的方面最重要的是他们在临终前的治疗decisions.METHODS：参与者包括23例患者，60岁及以上的充血性心力衰竭（CHF），慢性阻塞性肺疾病（COPD），或癌症的初步诊断，由他们的医生确定为具有有限的预期寿命。他们参加了深入的半结构化访谈和焦点小组，在这些访谈中，他们被要求讨论他们以前如何做出关于治疗疾病的决定和/或如何考虑做出未来的决定。成绩单进行了定性分析，使用常数comparative method.RESULTS：有三个主要的影响治疗偏好：治疗负担，治疗结果，结果的可能性。如果治疗结果令人满意，则治疗负担较小，但参与者不太愿意为更边缘的结果忍受负担。某些结果是如此不可接受，以至于它们决定了优先考虑，而不管负担如何。然而，一些参与者透露，随着疾病的进展，他们容忍这些不良后果的意愿可能会增加。虽然与会者普遍认为，医生知道肯定的治疗结果，最了解的概念不确定性，和一个给定的结果的可能性影响他们的preferences.CONCLUSIONS：以病人为中心的方法，以推进护理规划需要纳入治疗负担和治疗结果的考虑，包括这些结果的可能性。患者对这些结果的评价可能会随着时间的推移而改变。
BACKGROUND: Several methods exist to elicit end-of-life treatment preferences. However, little work has been done to elicit from patients themselves the aspects of treatment decision-making most important to them when making end-of-life treatment decisions.METHODS: Participants consisted of 23 patients, 60 years of age and older with a primary diagnosis of congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), or cancer identified by their physicians as having a limited life expectancy. They took part in in-depth semistructured interviews and focus groups in which they were asked to discuss how they had made previous decisions about the treatment of their illness and/or would think about making future decisions. Transcripts were analyzed qualitatively using the constant comparative method.RESULTS: There were three major influences on treatment preferences: treatment burden, treatment outcome, and the likelihood of the outcome. Treatment burden was bearable if the outcome of treatment was desirable, but participants were less willing to endure the burden for more marginal outcomes. Certain outcomes were so unacceptable that they determined preference regardless of burden. However, some participants revealed that their willingness to tolerate these adverse outcomes may increase as their illness progresses. Although participants generally believed that physicians know with certainty the outcomes of treatment, most understood the concept of uncertainty, and the likelihood of a given outcome influenced their preferences.CONCLUSIONS: A patient-centered approach to advance care planning needs to incorporate a consideration of both treatment burdens and treatment outcomes, including the likelihood of these outcomes. Patients' valuations of these outcomes may change over time.