Patient perspectives on states worse than death: A qualitative study with implications for patient-centered outcomes and values elicitation.
Patient perspectives on states worse than death: A qualitative study with implications for patient-centered outcomes and values elicitation.
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DOI：
10.1177/02692163211058596
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发表时间：
2022-02
影响因子：
4.4
通讯作者：
Halpern, Scott D.
中科院分区：
文献类型：
--
作者：
Auriemma, Catherine L.;O'Donnell, Helen;Jones, Julia;Barbati, Zoe;Akpek, Eda;Klaiman, Tamar;Halpern, Scott D.
重病患者将几种健康结果评为比死亡更糟糕的状态。目前尚不清楚此类评估的基础是什么因素，以及在做出医疗决策时考虑此类状态是否有用。我们试图（1）使用定性方法来识别比死亡更糟糕的状态，（2）识别这些不良健康状态的共同属性，以及（3）确定参与者如何使用这些状态的信息来做出医疗决策。半结构式访谈之质性研究-以内容分析法结合常数比较法为例。我们采访了65岁或65岁以上的成年人，他们从两家城市学术医院之一出院回家后患有严重疾病。有目的地对符合条件的患者进行抽样，以实现性别和种族的平衡。在29名参与者中，15名（52%）为女性，15名为白色（52%），中位年龄为72岁（四分位距69，75）。各种身体、认知和社会障碍被认为是比死亡更糟糕的状态。最常见的报道是，比死亡更糟糕的状态背后的属性是感知到亲人的负担和无法维持人际联系。患者认为，关于比死亡更糟糕的状态的信息必须个性化，并担心他们的意见可能会随着时间和健康状况的波动而改变。不良状态的共同因素表明，要以病人为中心的护理也必须以家庭为中心。患者在决策中使用比死亡更糟糕的状态的观点突出了使用避免这种状态作为质量度量的障碍，但也表明了引发患者价值观的机会。
Seriously ill patients rate several health outcomes as states worse than death. It is unclear what factors underlie such valuations, and whether consideration of such states is useful when making medical decisions. We sought to (1) use qualitative approaches to identify states worse than death, (2) identify attributes common to such undesirable health states, and (3) determine how participants might use information on these states in making medical decisions. Qualitative study of semi-structured interviews utilizing content analysis with constant comparison techniques. We interviewed adults age 65 or older with serious illnesses after discharge home from one of two urban, academic hospitals. Eligible patients were purposively sampled to achieve balance in gender and race. Of 29 participants, 15 (52%) were female, and 15 were white (52%), with a median age of 72 (interquartile range 69, 75). Various physical, cognitive, and social impairments were identified as states worse than death. The most commonly reported attributes underlying states worse than death were perceived burden on loved ones and inability to maintain human connection. Patients believed information on states worse than death must be individualized, and were concerned their opinions could change with time and fluctuations in health status. Common factors underlying undesirable states suggest that for care to be patient-centered it must also be family-centered. Patients’ views on using states worse than death in decision making highlight barriers to using avoidance of such states as a quality measure, but also suggest opportunities for eliciting patients’ values.
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影响因子：
6.3
作者：
Coe NB;Skira MM;Larson EB
通讯作者：
Larson EB
影响因子：
6.7
作者：
Hajek, Andre;Bock, Jens-Oliver;Koenig, Hans-Helmut
通讯作者：
Koenig, Hans-Helmut
影响因子：
5.7
作者：
Plassman, B. L.;Langa, K. M.;Wallace, R. B.
通讯作者：
Wallace, R. B.
DOI：
10.1177/0046958017751507
发表时间：
2018-02-09
影响因子：
1.7
作者：
Roberts, Emily;Struckmeyer, Kristopher M.
通讯作者：
Struckmeyer, Kristopher M.
影响因子：
8.8
作者：
Haines KJ;Hibbert E;McPeake J;Anderson BJ;Bienvenu OJ;Andrews A;Brummel NE;Ferrante LE;Hopkins RO;Hough CL;Jackson J;Mikkelsen ME;Leggett N;Montgomery-Yates A;Needham DM;Sevin CM;Skidmore B;Still M;van Smeden M;Collins GS;Harhay MO
通讯作者：
Harhay MO