Patient-family EoL communication and its predictors: Reports from caregivers of Latino patients in the rural US-Mexico border region
Patient-family EoL communication and its predictors: Reports from caregivers of Latino patients in the rural US-Mexico border region
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DOI：
10.1017/s147895151700092x
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发表时间：
2018-10-01
影响因子：
2.2
通讯作者：
Martinez, Stephanie
中科院分区：
文献类型：
--
作者：
Ko, Eunjeong;Lee, Jaehoon;Martinez, Stephanie
目的：当患者无法做出自己的决定时，家庭照顾者在临终（EoL）决策中发挥重要作用。虽然患者和家属之间关于EoL护理的沟通可能是迈向高级护理计划（ACP）/EoL决策的第一步，但并非每种文化都非常重视关于这一主题的公开沟通。本研究的目的是探讨EoL沟通和沟通方面的照顾者之间的拉丁美洲病人在美国农村（美国）-墨西哥边境地区。方法：本研究分析了从美国农村家庭卫生机构的189名拉丁裔患者家庭护理人员收集的临终关怀需求评估数据。墨西哥边境地区。双变量检验和Logistic回归被用来解决我们的aims.Results：大约一半的家庭照顾者（n = 96，50.8%）报告说，曾经从事EoL与患者的讨论。EoL讨论的重要预测因素包括生命维持治疗偏好（比值比[OR] = 0.44，p < 0.05）;预先指令（AD）的知识（OR = 5.50，p < 0.01）;和不信任医生（OR = 0.29，p < 0.01）。那些宁愿延长他们所爱的人的生命，即使他/她不得不依靠生命支持的照顾者不太可能参与EoL通信。此外，担心医生可能想停止治疗的护理人员（即，过早地拔掉插头）不太可能这样做。相反，照顾者谁有知识的广告更有可能从事EoL communication.Significance的结果：EoL沟通是一个复杂的过程，受个人，社会和文化价值观和信仰的病人和他/她的家人。在ACP过程中包括家庭护理人员，并促进患者和家庭护理人员之间的文化定制EoL沟通是很重要的。
Objective:Family caregivers play an important role in end-of-life (EoL) decision making when the patient is unable to make his/her own decisions. While communication about EoL care between patients and family is perhaps a first step toward advance care planning (ACP)/EoL decisions, not every culture puts great value on open communication about this topic. The aims of the present study were to explore EoL communication and the aspects of communication among caregivers of Latino patients in the rural United States (U.S.)-Mexico border region.Method:This study analyzed data from a hospice needs assessment collected from 189 family caregivers of Latino patients at a home health agency in a rural U.S.-Mexico border region. Bivariate tests and logistic regression were used to address our aims.Results:About half of the family caregivers (n = 96, 50.8%) reported to have ever engaged in EoL discussion with patients. Significant predictors of EoL discussion included life-sustaining treatment preference (odds ratio [OR] = 0.44, p < 0.05); knowledge of an advance directive (AD) (OR = 5.50, p < 0.01); and distrust of physicians (OR = 0.29, p < 0.01). Caregivers who preferred extending the life of their loved one even if he/she had to rely on life supports were less likely to engage in EoL communication. Also, caregivers who worried that physicians might want to stop treatments (i.e., pull the plug) too soon were less likely to do so. Conversely, caregivers who had knowledge about ADs were more likely to engage in EoL communication.Significance of Results:EoL communication is a complex process influenced by individual, social, and cultural values and the beliefs of both the patient and his/her family. Inclusion of family caregivers in the ACP process and facilitating culturally tailored EoL communication between patients and family caregivers is important.