Physical functioning, depression, and preferences for treatment at the end of life: The Johns Hopkins Precursors Study
Physical functioning, depression, and preferences for treatment at the end of life: The Johns Hopkins Precursors Study
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DOI：
10.1111/j.1532-5415.2004.52165.x
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发表时间：
2004-04-01
影响因子：
6.3
通讯作者：
Gallo, JJ
中科院分区：
文献类型：
--
作者：
Straton, JB;Wang, NY;Gallo, JJ
目的：研究身体功能恶化与抑郁症和对维持生命治疗的偏好之间的关系。设计：对老年医生进行邮寄调查。设置：对约翰霍普金斯大学1948年至1964年毕业班的医学生进行纵向队列研究。参与者：在1998年完成维持生命治疗问卷并在1992年和1998年提供健康状况信息的医生（n=645，83%的受访者1998年的问卷调查，平均年龄68）。测量：偏好维持生命的治疗，评估使用一个清单问卷，在回答一个标准vignette.Results：645名医生，11%的经历了临床上显着下降的身体功能，18%的经历了6年期间的抑郁症恶化。具有临床意义的功能下降的医生更可能（调整后的比值比（AOR）=2.14，95%置信区间（CI）=1.18-3.88）偏好高负担的生命维持治疗。抑郁症的恶化大大改变了功能下降和治疗偏好之间的关联。功能下降和抑郁症恶化的医生更有可能（AOR=5.33，95%CI =1.60-17.8），更喜欢高负担的治疗比受访者没有下降的功能或恶化depression.Conclusion：这项研究呼吁注意需要临床重新评估的偏好，潜在的生命维持治疗时，健康下降，以防止低估的老年患者的偏好。
Objectives: To examine the relationship between worsening physical function and depression and preferences for life-sustaining treatment.Design: Mailed survey of older physicians.Setting: Longitudinal cohort study of medical students in the graduating classes from 1948 to 1964 at Johns Hopkins University.Participants: Physicians who completed the life-sustaining treatment questionnaire in 1998 and provided information about health status in 1992 and 1998 (n=645, 83% of respondents to the 1998 questionnaire; mean age 68).Measurements: Preferences for life-sustaining treatment, assessed using a checklist questionnaire in response to a standard vignette.Results: Of 645 physicians, 11% experienced clinically significant decline in physical functioning, and 18% experienced worsening depression over the 6-year period. Physicians with clinically significant functional decline were more likely (adjusted odds ratio (AOR)=2.14, 95% confidence interval (CI)=1.18-3.88) to prefer high-burden life-sustaining treatment. Worsening depression substantially modified the association between declining functioning and treatment preferences. Physicians with declining functioning and worsening depression were more likely (AOR=5.33, 95% CI=1.60-17.8) to prefer high-burden treatment than respondents without declining function or worsening depression.Conclusion: This study calls attention to the need for clinical reassessment of preferences for potentially life-sustaining treatment when health has declined to prevent underestimating the preferences of older patients.