Surrogate and physician understanding of patients' preferences for living permanently in a nursing home
Surrogate and physician understanding of patients' preferences for living permanently in a nursing home
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DOI：
10.1111/j.1532-5415.1997.tb01508.x
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发表时间：
1997-07-01
影响因子：
6.3
通讯作者：
Oye, RK
中科院分区：
文献类型：
--
作者：
Mattimore, TJ;Wenger, NS;Oye, RK
目的：评估患者永久居住在养老院的意愿以及代孕和医生对这一偏好的理解。设计：对来自队列研究的横断面访谈数据进行评估。研究地点：五个学术医疗中心。研究对象：接受研究的重病住院成年人，以了解预后以及对治疗结果和风险的偏好(支持)。测量：患者愿意永久住在养老院的意愿以5分制进行衡量，范围从“非常愿意”到“宁可死去”。使用有序Logistic回归来确定与这一偏好相关的患者的人口统计学和临床特征。结果：在9105名患者中，3262人(36%)回答了研究问题：7%的人“非常愿意”“永久地”住在养老院，19%的人“有点愿意”，11%的人不太愿意，26%的人非常不愿意，30%的人宁愿死。年龄越大，永久居住在养老院的意愿越低(优势比[OR]=每十年0.90；95%可信区间[CI]：0.85，0.96)。受教育程度高(OR=1.03/年；95%CI：1.00，1.05)、残障较多(OR=1.05/残障；95%CI：1.01，1.09)和黑人患者(OR=1.46，95%CI：1.20，1.76)的患者更愿意住在养老院。代理人了解61%的患者的疗养院偏好，但只有35%的患者愿意永久住在疗养院。医生确定了18%的患者愿意永久住在养老院。结论：患者对永久住在养老院的态度是可以引起的，不能从人口统计学和临床变量中可靠地预测，而且经常被代理人和医生误解。在患者不能参与决策之前，应该探索患者对永久养老院安置的偏好，以增强患者偏好与他们度过生命末期的方式的一致性。
OBJECTIVE: To evaluate patients' willingness to live permanently in a nursing home and surrogate and physician understanding of that preference.DESIGN: Evaluation of cross-sectional interview data from a cohort study. SETTING: Five academic medical centers.PARTICIPANTS: Seriously ill hospitalized adults enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT).MEASUREMENTS: Patients' willingness to live permanently in a nursing home was measured on a 5-point scale ranging from ''very willing'' to ''rather die.'' Ordinal logistic regression was used to identify patient demographic and clinical characteristics associated with this preference. Surrogate and physician perceptions of patient preferences were compared with patients' responses, and factors associated independently with surrogate and physician understanding of patient preference were identified.RESULTS: Of 9105 patients, 3262 (36%) provided responses to the study question: 7% were ''very willing'' to live permanently in a nursing home, 19% ''somewhat willing,'' 11% ''somewhat unwilling,'' 26% ''very unwilling,'' and 30% would ''rather die.'' Older age was associated independently with less willingness to live permanently in a nursing home (odds ratio [OR]=.90 per decade; 95% confidence interval [CI]: 0.85, 0.96). Patients with more education (OR = 1.03 per year; 95% CI:1.00,1.05) and more disabilities (OR = 1.05 per disability; 95% CI:1.01,1.09), and black patients (OR = 1.46 compared with white patients; 95% CI:1.20,1.76) were more willing to live in a nursing home. Surrogates understood 61% of patients' nursing home preferences but identified only 35% of patients who were willing to live permanently in a nursing home. Physicians identified 18% of patients willing to live permanently in a nursing home.CONCLUSION: Patient attitudes about living permanently in a nursing home can be elicited, cannot be reliably predicted from demographic and clinical variables, and are frequently misunderstood by surrogates and physicians. Elicitation of patient preferences regarding permanent nursing home placement should be explored before patients become unable to participate in decision making in order to enhance the concordance of patient preference with the way they spend the end of their lives.