Improving Decision-Making for Feeding Options in Advanced Dementia: A Randomized, Controlled Trial
Improving Decision-Making for Feeding Options in Advanced Dementia: A Randomized, Controlled Trial
复制标题
DOI：
10.1111/j.1532-5415.2011.03629.x
复制
发表时间：
2011-11-01
影响因子：
6.3
通讯作者：
Mitchell, Susan L.
中科院分区：
文献类型：
--
作者：
Hanson, Laura C.;Carey, Timothy S.;Mitchell, Susan L.
目的：设计：整群随机对照试验，地点：北卡罗来纳州24家疗养院，参与者：患有晚期痴呆和喂养问题的居民及其代理人，干预：干预代理人接受了关于晚期痴呆喂养选择的音频或打印决策辅助。对照组接受了通常的care.MEASUREMENTS：主要结果是决策冲突量表（范围：1-5）在3个月测量;其他主要结果是代理知识，与供应商的沟通频率，喂养治疗use.RESULTS：二百五十六居民和代理决策者被招募。居民的平均年龄为85岁，67%为白人，79%为女性。代理人的平均年龄为59岁; 67%是白人，70%是居民的孩子。干预改善了知识得分（16.8 vs 15.1，P < .001）。3个月后，干预代理人的决策冲突量表评分低于对照组（1.65 vs 1.90，P < .001），并且更经常与医疗保健提供者讨论喂养选择（46% vs 33%，P = .04）。干预组的居民更有可能接受吞咽困难饮食（89% vs 76%，P = .04），并显示出更大的工作人员饮食援助的趋势（20% vs 10%，P = .08）。管喂养是罕见的，在两组，即使9个月后（1干预与3控制，P = .34）。结论：决策援助喂养选择在晚期痴呆症减少决策冲突的代理人，并增加他们的知识和沟通喂养选择与供应商。J Am Geriatr Soc 59：2009-2016，2011.
OBJECTIVES: To test whether a decision aid improves quality of decision-making about feeding options in advanced dementia.DESIGN: Cluster randomized controlled trial.SETTING: Twenty-four nursing homes in North Carolina.PARTICIPANTS: Residents with advanced dementia and feeding problems and their surrogates.INTERVENTION: Intervention surrogates received an audio or print decision aid on feeding options in advanced dementia. Controls received usual care.MEASUREMENTS: Primary outcome was the Decisional Conflict Scale (range: 1-5) measured at 3 months; other main outcomes were surrogate knowledge, frequency of communication with providers, and feeding treatment use.RESULTS: Two hundred fifty-six residents and surrogate decision-makers were recruited. Residents' average age was 85; 67% were Caucasian, and 79% were women. Surrogates' average age was 59; 67% were Caucasian, and 70% were residents' children. The intervention improved knowledge scores (16.8 vs 15.1, P < .001). After 3 months, intervention surrogates had lower Decisional Conflict Scale scores than controls (1.65 vs 1.90, P < .001) and more often discussed feeding options with a healthcare provider (46% vs 33%, P = .04). Residents in the intervention group were more likely to receive a dysphagia diet (89% vs 76%, P = .04) and showed a trend toward greater staff eating assistance (20% vs 10%, P = .08). Tube feeding was rare in both groups even after 9 months (1 intervention vs 3 control, P = .34).CONCLUSION: A decision aid about feeding options in advanced dementia reduced decisional conflict for surrogates and increased their knowledge and communication about feeding options with providers. J Am Geriatr Soc 59:2009-2016, 2011.