Older Adults' Recognition of Trade-Offs in Healthcare Decision-Making.
Older Adults' Recognition of Trade-Offs in Healthcare Decision-Making.
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DOI：
10.1111/jgs.13534
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发表时间：
2015-08
影响因子：
6.3
通讯作者：
Fried TR
中科院分区：
文献类型：
--
作者：
Case SM;O'Leary J;Kim N;Tinetti ME;Fried TR
探讨老年人对涉及权衡的医疗保健决策的理解。横断面调查初级保健诊所社区生活65岁及以上的人在被要求考虑以慢性病管理为重点的权衡之后，参与者被要求描述他们过去做出的一个涉及权衡的决定。如果不能，他们被要求描述一个他们未来可能面临的决定，然后给出一个决定的例子。他们还被问及在面临权衡时，与初级保健提供者就他们的优先事项进行沟通。在50名参与者中，44人（88%）能够描述一个涉及权衡的医疗保健决定；25人提供了过去的决定，17人提供了他们未来可能面临的决定，2人在听了一个例子后提供了未来的决定。一名参与者描述了一个非医疗决定，两名参与者描述了没有提供权衡的目标。在医疗保健决定中，26个涉及手术，7个涉及临终决定，7个涉及慢性疾病的治疗，4个涉及化疗。当被问及服务提供者是否应了解其健康结果优先事项时，44人（88%）回答是；35人（70%）认为他们的医疗服务提供者知道他们的优先事项；然而，只有18人（36%）表示他们曾就优先事项进行过具体讨论。大多数参与者能够认识到医疗保健决策所涉及的权衡，并希望他们的提供者了解他们在权衡方面的优先事项。尽管参与者已经准备好考虑日常慢性疾病治疗中涉及的权衡，但他们最常描述的是偶发的、高风险的决定，包括手术和临终关怀。
To examine older persons’ understanding of healthcare decision making involving tradeoffs. Cross-sectional survey Primary care clinics Community-living persons age 65 years and older After being primed to think about tradeoffs with a focus on chronic disease management, participants were asked to describe a decision they had made in the past involving a tradeoff. If they could not, they were asked to describe a decision they might face in the future and were then given an example of a decision. They were also asked about communication with their primary care provider about their priorities when faced with a tradeoff. Of the 50 participants, 44 (88%) were able to describe a healthcare decision involving a tradeoff; 25 provided a decision in the past, 17 provided a decision they might face in the future, and 2 provided a future decision after hearing an example. One participant described a non-medical decision and two participants described goals without providing a tradeoff. Of the healthcare decisions, 26 involved surgery, seven were end-of life decisions, seven regarded treatment of chronic disease, and four involved chemotherapy. When asked whether their providers should know their health outcome priorities, 44 (88%) replied yes; 35 (70%) believed their providers knew their priorities; however, only 18 (36%) said that they had a specific conversation about priorities. The majority of participants were able to recognize the tradeoffs involved in healthcare decision making and wanted their providers to know their priorities regarding the tradeoffs. Despite being primed to think about the tradeoffs involved in day-to-day treatment of chronic disease, participants most frequently described episodic, high-stakes decisions including surgery and end-of-life care.