Improving Decision Making at the End of Life With Video Images
Improving Decision Making at the End of Life With Video Images
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DOI：
10.1177/0272989x09341587
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发表时间：
2010-01-01
影响因子：
3.6
通讯作者：
Paasche-Orlow, Michael K.
中科院分区：
文献类型：
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作者：
Volandes, Angelo E.;Barry, Michael J.;Paasche-Orlow, Michael K.
背景资料。在生命末期的决策往往是复杂的，而且往往充满不确定性。我们假设，健康素养有限的人比健康素养足够的人在临终决策方面有更多的不确定性。我们还假设视频图像将减少不确定性。设计。在口试前后进行调查。与会者。受试者向他们的初级保健医生介绍。方法：研究方法。受试者在听到对晚期痴呆症的口头描述后，被问及他们对临终关怀的偏好，并被要求对他们的不确定性水平进行评级。然后，受试者观看了一位晚期痴呆症患者的视频，并再次被问及他们的偏好和不确定性。使用决策冲突量表测量不确定性，得分范围从3(高不确定性)到15(无不确定性)。采用成人医学素养快速评估量表测量健康素养，并将受试者分为3个识字类别：低(0-45岁，6年级及以下)、边缘(46-60岁，7-8年级)和适中(61-66岁，9年级及以上)。结果。共有146名患者完成了采访。在视频之前，低健康素养、边缘健康素养和足够健康素养的受试者的平均不确定度分数分别为10.8、12.4和13.5(P<；0.0001)。在视频之后，这三组人对他们的决定也有类似的不确定性。低健康素养、边缘健康素养和高健康素养被试的平均不确定度得分分别为13.6、14.1和14.5(P=0.046)。结论。健康素养有限的受试者比具有足够健康素养的受试者对其临终关怀的偏好表现出更多的不确定性。我们的视频决策帮助改善了临终决策，减少了关于受试者偏好的不确定性，特别是对那些识字率有限的人。
Background. Decision making at the end of life is frequently complex and often filled with uncertainty. We hypothesized that people with limited health literacy would have more uncertainty about end-of-life decision making than people with adequate literacy. We also hypothesized that video images would decrease uncertainty. Design. Before and after oral survey. Participants. Subjects presenting to their primary care physicians. Methods. Subjects were asked about their preferences for end-of-life care after they heard a verbal description of advanced dementia and were asked to rate the level of their uncertainty. Subjects then viewed a video of a patient with advanced dementia and were asked again about their preferences and uncertainty. Uncertainty was measured using the Decisional Conflict Scale with score ranges from 3 (high uncertainty) to 15 (no uncertainty). Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine, and subjects were divided into 3 literacy categories: low (0-45, 6th grade and below), marginal (46-60, 7th- 8th grade), and adequate (61-66, 9th grade and above). Results. A total of 146 patients completed the interview. Prior to the video, the average uncertainty scores for subjects with low, marginal, and adequate health literacy were 10.8, 12.4, and 13.5, respectively (P < 0.0001). After the video, the 3 groups had similar uncertainty about their decisions. The average uncertainty scores for subjects with low, marginal, and adequate health literacy were 13.6, 14.1, and 14.5, respectively (P = 0.046). Conclusions. Subjects with limited health literacy expressed more uncertainty about their preferences for end-of-life care than did subjects with adequate literacy. Our video decision aid improved end-of-life decision making by decreasing uncertainty regarding subjects' preferences, especially for those with limited literacy.