"I Don't Want to Die Like That ... ": The Impact of Significant Others' Death Quality on Advance Care Planning
"I Don't Want to Die Like That ... ": The Impact of Significant Others' Death Quality on Advance Care Planning
复制标题
DOI：
10.1093/geront/gns051
复制
发表时间：
2012-12-01
期刊：
影响因子：
5.7
通讯作者：
Carr, Deborah
中科院分区：
文献类型：
--
作者：
Carr, Deborah
研究目的：我研究了重要的另一个人的死亡质量的5个方面（痛苦、决策能力、地点、临终关怀问题和准备）是否影响一个人是否提前护理计划（ACP）。我还指出了受访者所说的触发他们自己计划的其他人死亡的具体方面。设计和方法：数据来自新泽西州生命终结研究，该研究对305名55岁以上的成年人进行了调查，他们在新泽西州的两个主要医疗中心寻求治疗。我估计了253个最近失去亲人的参与者的子样本的多变量逻辑回归模型，并从一个关于一个人的ACP动机的开放式问题中提供描述性结果。结果：多变量分析显示正向榜样效应；目睹重要他人在家中死亡的人，不存在与临终关怀有关的问题，在使用预先指示的情况下，更有可能做好临终准备。开放式数据显示，19%的人认为别人的死亡是他们自己计划的主要诱因，其中大多数人提到了他们希望避免的负面因素（疼痛、与机器的联系、昏迷）。启示：从业者应鼓励患者以他人死亡的对话为跳板，讨论自己的临终关怀，并与家人一起参与ACP。强调了对医疗改革的影响。
Purpose of the Study: I examine whether 5 aspects of a significant other's death quality (pain, decision-making capacity, location, problems with end-of life care, and preparation) affect whether one does advance care planning (ACP). I also identify specific aspects of others' deaths that respondents say triggered their own planning. Design and Methods: Data are from the New Jersey End of Life study, a survey of 305 adults age 55+ seeking care at 2 major New Jersey medical centers. I estimate multivariate logistic regression models for a subsample of 253 participants who recently lost a loved one and provide descriptive findings from an open-ended question regarding the motivation for one's ACP. Results: Multivariate analyses revealed "positive" role model effects; persons who witnessed significant others' deaths that occurred at home, were free of problems associated with end-of-life care, and where advance directives were used are more likely to make end-of-life preparations. Open-ended data showed that 19% cited others' deaths as the main trigger for their own planning, with most citing negative factors (pain, connection to machines, coma) that they hoped to avoid. Implications: Practitioners should encourage patients to use conversations about others' deaths as springboards for discussions about one's own end-of-life care, and to engage in ACP together with family. Implications for health care reform are highlighted.