Approaching the end of life: Attitudes, preferences, and behaviors of African-American and white patients and their family caregivers
Approaching the end of life: Attitudes, preferences, and behaviors of African-American and white patients and their family caregivers
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DOI：
10.1200/jco.2003.12.080
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发表时间：
2003-02-01
影响因子：
45.3
通讯作者：
Braitman, LE
中科院分区：
文献类型：
--
作者：
Phipps, E;True, G;Braitman, LE
目的：为了调查不同的态度，偏好和行为，对生命的最后在绝症患者和他们指定的家庭carefer.Patients和方法：68名非洲裔美国人和白色患者与第三B或第四期肺癌或第四期结肠癌和68名患者指定的家庭照顾者在1999年12月和2001年5月之间进行了采访。与非裔美国人相比，白色患者更有可能拥有持久的委托书（34%对8%，P = .01），更有可能拥有生前遗嘱（LW; 41%对11%，P = .004）。在目前的情况下，更多的非洲裔美国人比白色患者希望使用生命维持措施（心肺复苏[CPR]，机械通气，管饲）（所有P > 0.12）。在濒临死亡的情况下，非裔美国患者比白色患者更希望获得每一种生命维持措施（P <0.004）。在患者当前状况下或濒临死亡的情况下，患者-护理人员对于开始CPR、管饲或机械通气的偏好没有超出偶然性的一致意见。在濒临死亡的情况下，在没有LWs的患者，有分歧的46%的病人照顾者对心肺复苏术，在50%的机械通气，并在43%的管feeding.Conclusion：虽然大多数患者和家庭赞同的首要地位的病人在生命结束时的决定，大多数不采取支持行动。患者和家属之间关于在没有LW的患者中使用生命维持措施的分歧可能导致患者的偏好在生命结束时被取代。(C)2003年，美国临床肿瘤学会。
Purpose : To investigate differences in attitudes, preferences, and behaviors regarding end of life in terminally ill patients and their designated family caregivers.Patients and Methods: 68 African-American and white patients with stage III-B or IV lung or stage IV colon cancer and 68 patient-designated family caregivers interviewed between December 1999 and May 2001.Results: White patients were more likely to have a durable power of attorney (34% v 8%, P = .01) and were more likely to have a living will (LW; 41% v 11%, P = .004) than were African-American patients. More African-American than white patients desired the use of life-sustaining measures (cardiopulmonary resusitation [CPR], mechanical ventilation, tube feeding) in their current condition (all P > .12). In a near-death condition, African-American patients were more likely than white patients to desire each of the life-sustaining measures (all P < .004). There was no patient-caregiver agreement beyond chance regarding preferences for initiation of CPR, tube feeding, or mechanical ventilation in the patient's current condition or in the near-death condition. In the near-death condition in patients without LWs, there was disagreement in 46% of patient-caregiver pairs about CPR, in 50% about mechanical ventilation, and in 43% about tube feeding.Conclusion: Although most patients and families endorse the primacy of the patient in decisions at end of life, the majority do not take supporting actions. Disagreements between patients and families about the use of life-sustaining measures in patients without LWs may result in patients' preferences being superseded at end of life. (C) 2003 by American Society of Clinical Oncology.