Timing of Advance Directive Completion and Relationship to Care Preferences
Timing of Advance Directive Completion and Relationship to Care Preferences
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DOI：
10.1016/j.jpainsymman.2016.08.008
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发表时间：
2017-01-01
影响因子：
4.7
通讯作者：
Ailshire, Jennifer
中科院分区：
文献类型：
--
作者：
Enguidanos, Susan;Ailshire, Jennifer
背景。鉴于近期医疗保险规则对临床医生参与预先护理规划进行补偿，人们愈发需要了解与临终前完成预先指示（AD）的时间相关的因素，以及该时间如何影响护理决策。
目的。本研究旨在调查预先指示完成时间的模式以及时间与记录的护理偏好之间的关系。我们假设在疾病过程后期或疾病轨迹极早期完成的预先指示将反映出对积极治疗更高的偏好。
方法。我们进行了一项回顾性研究，使用逻辑回归分析来自健康与退休研究的数据，该研究是一项针对老年人的具有全国代表性的纵向调查。
结果。分析样本包括2000年至2012年期间对2904名有预先指示的已故参与者的代理人进行的离职访谈。近四分之三（71%）的预先指示在死亡前一年或更早完成。较年轻或属于种族/族裔少数群体、教育程度较低、被诊断患有癌症或肺病以及预期死亡与在死亡前三个月内完成预先指示相关，而资产处于最低四分位数和有记忆问题则与预先指示的完成呈负相关。少数族裔、教育程度较低者、预期死亡以及预先指示完成的时间与选择积极治疗相关。
结论。早期记录护理意愿可能与选择积极治疗的可能性增加无关；然而，在生命的最后几个月完成的预先指示选择积极治疗的比率更高。（C）2016美国临终关怀与姑息医学学会。由爱思唯尔公司出版。保留所有权利。
Context. Given recent Medicare rules reimbursing clinicians for engaging in advance care planning, there is heightened need to understand factors associated with the timing of advance directive (AD) completion before death and how the timing impacts care decisions.Objective. The purpose of this study was to investigate patterns in timing of AD completion and the relationship between timing and documented care preferences. We hypothesize that ADs completed late in the course of illness or very early in the disease trajectory will reflect higher preferences for aggressive care.Methods. We conducted a retrospective study using logistic regressions to analyze data from the Health and Retirement Study, a nationally representative longitudinal survey of older adults.Results. The analytic sample included exit interviews conducted from 2000 to 2012 among 2904 proxy reporters of deceased participants who had an AD. Nearly three-quarters (71%) of ADs were completed a year or more before death. Being younger or a racial/ethnic minority, and having lower education, a diagnosis of cancer or lung disease, and an expected death were associated with completing an AD within the three months before death, while having the lowest quartile of assets and memory problems were inversely associated with AD completion. Minorities, those with lower education, expected death, and timing of AD completion were associated with electing aggressive care.Conclusion. Early documentation of care wishes may not be associated with an increased likelihood of electing aggressive care; however, ADs completed in the last months of life have higher rates of election of aggressive care. (C) 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.