Non-Concordance between Patient and Clinician Estimates of Prognosis in Advanced Heart Failure.
Non-Concordance between Patient and Clinician Estimates of Prognosis in Advanced Heart Failure.
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DOI：
10.1016/j.cardfail.2021.03.005
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发表时间：
2021-06
影响因子：
6
通讯作者：
Goldstein NE
中科院分区：
文献类型：
--
作者：
Gelfman LP;Mather H;McKendrick K;Wong AY;Hutchinson MD;Lampert RJ;Lipman HI;Matlock DD;Swetz KM;Pinney SP;Morrison RS;Goldstein NE
尽管努力加强重症疾病沟通，但晚期心力衰竭（HF）患者缺乏对预后的了解。
确定心力衰竭患者对自身预后的估计与其医生对患者预后的估计之间的一致性比率，并比较与一致性相关的患者特征。
对一项为期24个月随访的整群随机对照试验进行横断面分析，分析于2020年9月1日完成。患者于2011年9月至2016年2月期间在住院和门诊环境中入组，数据收集持续到2017年最后一个季度。
美国的6家教学医院。
患有晚期心力衰竭且植入式心脏复律除颤器（ICD）处于高死亡风险的患者。在原始研究的537名患者中，407名患者有用于此次分析的完整数据。
一项关于心力衰竭临床医生与其患者之间关于ICD停用和预先护理计划的对话的多成分沟通干预措施。
患者对预后的自我报告以及医生对12个月预后“意外问题”的回答。以百分比一致性和卡帕值衡量患者 - 医生预后一致性（PPPC）。对有和没有PPPC的患者特征进行双变量分析。
在407名患者（平均年龄62.1岁，29.5%为女性，42.4%为非白人）中，300名（73.7%）患者 - 医生对无PPPC；其中252名（84.0%）在其医生估计小于1年时报告预后大于1年。只有107名（26.3%）有PPPC，预后为≤1年（n = 20名患者）或>1年（n = 87名患者）；（K = -0.20，p = 1.0）。在医生估计预后小于1年的患者中，症状负担（数量和严重程度）较低（两者p≤.001）且未完成预先指示（p =.001）的患者更可能出现无PPPC情况。在医生预后估计大于1年的患者中，没有患者特征与PPPC或无PPPC相关。
心力衰竭患者与其医生之间无PPPC的情况很常见。心力衰竭患者在估计预期寿命方面比临床医生更乐观。这些数据表明，有机会提高晚期心力衰竭患者与其医生之间预后告知的质量。改善PPPC的干预措施可能包括重症疾病沟通培训。
Clinicaltrials.gov - NCT01459744 https://clinicaltrials.gov/ct2/show/NCT01459744
Despite efforts to enhance serious illness communication, patients with advanced heart failure (HF) lack prognostic understanding. To determine rate of concordance between HF patients’ estimation of their prognosis and their physician’s estimate of the patient’s prognosis, and to compare patient characteristics associated with concordance. Cross-sectional analysis of a cluster randomized controlled trial with 24-month follow-up and analysis completed on 09/01/2020. Patients were enrolled in inpatient and outpatient settings between September 2011 to February 2016 and data collection continued until the last quarter of 2017. Six teaching hospitals in the U.S. Patients with advanced HF and implantable cardioverter defibrillators (ICDs) at high risk of death. Of 537 patients in the parent study, 407 had complete data for this analysis. A multi-component communication intervention on conversations between HF clinicians and their patients regarding ICD deactivation and advance care planning. Patient self-report of prognosis and physician response to the “surprise question” of 12-month prognosis. Patient-physician prognostic concordance (PPPC) measured in percentage agreement and kappa. Bivariate analyses of characteristics of patients with and without PPPC. Among 407 patients (mean age 62.1 years, 29.5% female, 42.4% non-white), 300 (73.7%) dyads had non-PPPC; of which 252 (84.0%) reported a prognosis >1 year when their physician estimated <1 year. Only 107 (26.3%) had PPPC with prognosis of ≤ 1 year (n=20 patients) or > 1 year (n=87 patients); (K = −0.20, p = 1.0). Of those with physician estimated prognosis of < 1 year, non-PPPC was more likely among patients with lower symptom burden- number and severity (both p ≤.001), without completed advance directive (p=.001). Among those with physician prognosis estimate > 1 year, no patient characteristic was associated with PPPC or non-PPPC. Non-PPPC between HF patients and their physicians is high. HF patients are more optimistic than clinicians in estimating life expectancy. These data demonstrate there are opportunities to improve the quality of prognosis disclosure between patients with advanced HF and their physicians. Interventions to improve PPPC might include serious illness communication training. Clinicaltrials.gov - NCT01459744 https://clinicaltrials.gov/ct2/show/NCT01459744
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影响因子：
4.4
作者：
Warraich, Haider Javed;Allen, Larry A.;Kociol, Robb D.
通讯作者：
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影响因子：
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DOI：
10.1046/j.1532-5415.2003.51457.x
发表时间：
2003-10-01
影响因子：
6.3
作者：
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通讯作者：
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影响因子：
24
作者：
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通讯作者：
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