Advance care planning for patients with amyotrophic lateral sclerosis.
Advance care planning for patients with amyotrophic lateral sclerosis.
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DOI：
10.1080/21678421.2017.1285317
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发表时间：
2017-08
影响因子：
2.8
通讯作者：
Green MJ
中科院分区：
文献类型：
--
作者：
Levi BH;Simmons Z;Hanna C;Brothers A;Lehman E;Farace E;Bain M;Stewart R;Green MJ
确定高级护理计划(ACP)决策辅助是否可以改善肌萎缩侧索硬化症(ALS)患者与其临床医生之间关于临终治疗意愿的沟通。44名肌萎缩侧索硬化症患者(≥，21岁，讲英语，无痴呆症)使用基于计算机的交互式决策辅助工具进行ACP。在参与者完成干预之前，以及3个月后，他们的临床医生回顾了3个临床片段，并为患者做出了治疗决定(n=18)。在患者表明他们同意该团队的决定后，计算了一致性。干预后患者意愿与临床团队决策的平均一致性显著提高(干预后=91.9%，95%CI=87.8，96.1；干预前=52.4%，95%CI=41.9，62.9；P<；.001)。临床团队成员报告说，与干预前(平均值=3.3，1=低，10=高，p<；.001)相比，他们的决定更有信心，即他们的决定准确地代表了干预后每个患者的意愿(平均值=6.5)。患者对临终关怀决策的满意度高(平均值=26.4，SD=3.2；6=低，30=高)，决策冲突低(平均值=28.8，SD=8.2；20=低，80=高)，对辅助决策的满意度高(平均值=52.7，SD=5.7，20=低，60=高)。患者对ACP的了解在干预后增加(干预前为47.8%，干预后为66.3%；p<；.001)，而不会对患者的焦虑或自我决定产生不利影响。基于计算机的ACP辅助决策可以显著提高临床医生对ALS患者临终关怀意愿的理解。
To determine whether an advance care planning (ACP) decision aid for could improve communication about end-of-life treatment wishes between patients with amyotrophic lateral sclerosis (ALS) and their clinicians. Fourty-four patients with ALS (≥21, English-speaking, without dementia) engaged in ACP using an interactive computer-based decision aid. Before participants completed the intervention, and again 3 months after, their clinicians reviewed 3 clinical vignettes, and made treatment decisions (n=18) for patients. After patients indicated their agreement with the team’s decisions, concordance was calculated. The mean concordance between patient wishes and the clinical team decisions was significantly higher post-intervention (post=91.9%, 95% CI=87.8, 96.1, vs. pre=52.4%, 95% CI=41.9, 62.9; p <.001). Clinical team members reported greater confidence that their decisions accurately represented each patient’s wishes post-intervention (mean=6.5) compared to pre-intervention (mean=3.3, 1=low, 10=high, p<.001). Patients reported high satisfaction (mean=26.4, SD=3.2; 6=low, 30=high) and low decisional conflict (mean=28.8, SD=8.2; 20=low, 80=high) with decisions about end-of-life care, and high satisfaction with the decision aid (mean=52.7, SD=5.7, 20=low, 60=high,). Patient knowledge regarding ACP increased post-intervention (pre=47.8% correct responses vs. post=66.3%; p <.001) without adversely effecting patient anxiety or self-determination. A computer-based ACP decision aid can significantly improve clinicians’ understanding of ALS patients’ wishes regarding end-of-life medical care.
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影响因子：
4.7
作者：
Downey, Lois;Au, David H.;Curtis, J. Randall;Engelberg, Ruth A.
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