The Influence of Patients' Quality of Life at the End of Life on Bereaved Caregivers' Suicidal Ideation
The Influence of Patients' Quality of Life at the End of Life on Bereaved Caregivers' Suicidal Ideation
复制标题
DOI：
10.1016/j.jpainsymman.2013.09.011
复制
发表时间：
2014-09-01
影响因子：
4.7
通讯作者：
Maciejewski, Paul K.
中科院分区：
文献类型：
--
作者：
Abbott, Caroline H.;Prigerson, Holly G.;Maciejewski, Paul K.
上下文。最近的研究表明，患者在生命结束时的生活质量（QOL@EOL）会影响失去亲人的家庭照顾者的心理社会适应。目的探讨患者QOL@EOL与遗属照顾者自杀意念的关系。数据来源于应对癌症（CwC1）研究，这是一项由美国国家癌症研究所资助的针对晚期癌症患者及其护理人员的多中心前瞻性队列调查，患者于2002年9月至2008年2月入组。CwC1数据用于检查患者死亡前后家庭照顾者自杀意念的变化（N = 127）。护理者基线自杀意念采用耶鲁自杀评估量表（YES）进行评估，中位数为自杀前4.1个月；护理人员对患者QOL@EOL的感知在失智后1.9个月进行评估；和照顾者自杀意念在丧亲后6.5个月的中位数使用YES进行评估。自杀意念被定义为YES的阳性筛选。我们采用多元逻辑回归分析，在调整护理者基线自杀意念及混杂影响后，检验护理者对患者QOL@EOL的认知对丧亲照护者自杀意念的影响。在调整了护理人员的基线自杀意念、与患者的关系、受教育年限后，护理人员对患者QOL@EOL的感知与护理人员的自杀意念呈显著负相关（校正优势比0.79,P = 0.023）。照顾者越认为他们所爱的人QOL@EOL贫穷，他们在丧亲之痛中产生自杀意念的风险就越大，高于之前的自杀意念水平。患有QOL@EOL疾病的患者的护理人员似乎是降低自杀风险的护理人员群体。(C) 2014年美国临终关怀与姑息医学学会。Elsevier Inc.出版。版权所有。
Context. Recent studies have shown that patients' quality of life at the end of life (QOL@EOL) affects the psychosocial adjustment of bereaved family caregivers.Objectives. To examine the relationship between patients' QOL@EOL and the suicidal ideation of their surviving bereaved caregivers.Methods. Data were derived from the Coping with Cancer (CwC1) Study, a U.S. National Cancer Institute-funded multicenter prospective cohort investigation of patients with advanced cancer and their caregivers, in which patients were enrolled September 2002 to February 2008. CwC1 data were used to examine changes in suicidal ideation in family caregivers before and after the patient's death (N = 127). Caregiver baseline suicidal ideation was assessed using the Yale Evaluation of Suicidality (YES) Scale a median of 4.1 months pre-loss; caregivers' perception of patients' QOL@EOL was assessed a median of 1.9 months postloss; and caregiver suicidal ideation in bereavement was assessed using the YES a median of 6.5 months postloss. Suicidal ideation was defined as a positive screen on the YES. We used multiple logistic regression analysis to examine the effect of caregivers' perceptions of patients' QOL@EOL on the suicidal ideation of bereaved caregiver's, adjusting for the caregiver's baseline suicidal ideation and confounding influences.Results. Caregivers' perception of patients' QOL@EOL was significantly inversely related to caregivers' suicidal ideation postloss (adjusted odds ratio 0.79, P = 0.023), after we adjusted for caregivers' baseline suicidal ideation, relationship to patient, and years of education.Conclusion. The more caregivers perceive their loved ones' QOL@EOL to be poor, the greater their risk for suicidal ideation in bereavement over and above prior levels of suicidal ideation. Caregivers of patients who have poor QOL@EOL appear to be a group of caregivers to target for reduction of suicidal risk. (C) 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.