Comfort goal of care and end-of-life outcomes in dementia: A prospective study
Comfort goal of care and end-of-life outcomes in dementia: A prospective study
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痴呆症护理的舒适目标和临终结果：一项前瞻性研究
DOI：
10.1177/0269216315570409
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发表时间：
2015
影响因子：
4.4
通讯作者：
B. Onwuteaka
中科院分区：
文献类型：
--
作者：
Mirjam C. van Soest;J. T. van der Steen;H. D. de Vet;C. Hertogh;L. Deliens;B. Onwuteaka
背景：许多痴呆症患者在养老院去世。舒适护理目标可能是有益的。很少有研究探讨护理目标和结果之间的关系。目的：调查家属对临终关怀和死亡质量的满意度是否与痴呆患者入院后不久是否有舒适目标相关。设计和设置：前瞻性数据收集从28个长期护理设施（荷兰老年痴呆症研究的生命结束）。我们纳入了148名在前瞻性随访后死亡的患者。主要结局是家庭满意度（痴呆症患者生命终末期-护理满意度量表;范围：10-40）和死亡质量（痴呆症患者生命终末期-死亡舒适度评估;范围：14-42）。我们进行了广义估计方程回归分析，以分析这些结果是否与入院后不久建立的舒适目标相关联，与医生报告的另一个或无护理目标相比。结果：病人家属对临终关怀的满意度更高时，舒适的目标是成立后不久入院。我们发现这种模式仅适用于入院后6个月内死亡的患者（校正后的B：4.5;置信区间：2.8，6.3 vs −1.2;置信区间：−3.0，0.6，对于更长的住院时间）。死亡的质量，没有这样的协会被发现。结论：我们发现，家庭满意度与护理有关的舒适护理目标入院后不久，但死亡的质量没有。在早期阶段建立一个舒适的目标可能对家庭很重要。应研究预先护理计划干预措施对患者和家庭结局的影响。
Background: Many people with dementia die in a nursing home. A comfort care goal may be beneficial. Little research has examined the relationship between care goals and outcome. Aim: To investigate whether family satisfaction with end-of-life care and quality of dying is associated with whether or not dementia patients have a comfort goal shortly after admission. Design and setting: Prospective data collection from 28 long-term care facilities (the Dutch End of Life in Dementia study). We included 148 patients who died after prospective follow-up. Main outcomes were family satisfaction (End-of-Life in Dementia–Satisfaction with Care scale; range: 10–40) and quality of dying (End-of-Life in Dementia-Comfort Assessment in Dying; range: 14–42). We performed generalized estimating equations regression analyses to analyze whether these outcomes are associated with a comfort goal established shortly after admission compared with another or no care goal as reported by the physician. Results: Families of patients were more satisfied with end-of-life care when a comfort goal was established shortly after admission. We found this pattern only for patients who died within 6 months of admission (adjusted b: 4.5; confidence interval: 2.8, 6.3 vs −1.2; confidence interval: −3.0, 0.6 for longer stay). For quality of dying, no such association was found. Conclusion: We found that family satisfaction with care is related to a comfort care goal shortly after admission, but quality of dying did not. Establishing a comfort goal at an early stage may be important to the family. Advance care planning interventions should be studied for their effects on patient and family outcome.