Stability and change in patient preferences and spouse substituted judgments regarding dialysis continuation.
Stability and change in patient preferences and spouse substituted judgments regarding dialysis continuation.
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患者偏好和配偶的稳定性和变化取代了关于继续透析的判断。
DOI：
10.1093/geronb/63.2.s81
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
Wilson-Genderson,Maureen
中科院分区：
文献类型：
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作者：
Pruchno,RachelA;Rovine,MichaelJ;Cartwright,Francine;Wilson-Genderson,Maureen
目的：本研究的目的是检验一些治疗偏好是否比其他的更稳定，患者的偏好和替代判断是如何随着时间的推移而变化的，以及一些人的决定是否比其他人的更稳定。方法：假设情景在两个时间点引发了在不同健康条件下继续透析的偏好。预测因素包括初始治疗偏好、年龄、性别、种族、教育程度、透析时间、生前意愿和患者健康变化。结果：一些治疗偏好比其他治疗偏好更稳定，这种稳定性的原因因治疗偏好而异。夫妻之间患者偏好和配偶替代判断之间的相似性很低，并随着假设条件的不同而变化。对随访时治疗偏好的最强预测因子是初始偏好。年龄、性别、种族、教育程度、透析时间、生前遗嘱的存在和患者健康状况的改变对治疗偏好的改变影响有限。讨论：与患者偏好的改变和对1年以上持续透析的替代判断相比，稳定性要大得多。这表明，如果患者以前表达了偏好，当患者本身无法表达自己的意愿时，这可能会在临终决定中保持他们的发言权。
Objectives.The objective of this study was to examine whether some treatment preferences are more stable than others, how patient preferences and substituted judgments change over time, and whether some people's decisions are more stable than others'.Methods.Hypothetical scenarios elicited preferences for dialysis continuation under various health conditions at two points in time. Predictors included initial treatment preference, age, gender, race, education, length of time on dialysis, presence of a living will, and change in patient's health.Results.Some treatment preferences were more stable than others, and the cause of this stability varied across treatment preferences. Similarity between patient preferences and spouse substituted judgments within couples was low and varied as a function of hypothetical condition. The strongest predictor of treatment preferences at follow-up was initial preference. Age, gender, race, education, length of time on dialysis, presence of a living will, and change in patient's health had limited effects on changes to treatment preferences.Discussion.There is a great deal more stability than change in patient preferences and substituted judgments regarding continuation of dialysis over the course of 1 year. This suggests that if patients have previously expressed preferences it is possible for this to maintain their voice in end-of-life decisions when the patients themselves are unable to express their wishes.