Changes in prognostic awareness among seriously ill older persons and their caregivers
Changes in prognostic awareness among seriously ill older persons and their caregivers
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DOI：
10.1089/jpm.2006.9.61
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发表时间：
2006-02-01
影响因子：
2.8
通讯作者：
O'Leary, John
中科院分区：
文献类型：
--
作者：
Fried, Terri R.;Bradley, Elizabeth H.;O'Leary, John
目的：探讨患者及护理人员对预后的认识随病情进展的变化。对象和方法：每4个月和更频繁地对60岁及以上的社区居民进行一次访谈，这些人患有严重的癌症、充血性心力衰竭或慢性阻塞性肺疾病，并且患者的病情下降长达一年。我们检查了基线和最接近死亡的访谈时的回答，“如果你必须猜测，你认为（你/病人）可能还能活多久？”结果：218例患者，1年内死亡87例。在最初的采访中，46%的人不确定自己的预期寿命（LE）， 9%的人认为预期寿命为1年或更短；在最后一次采访中，55%的人不确定，17%的人认为LE为1年或更短。在护理人员的初次访谈中，29%的人不确定患者的生活质量，20%的人认为生活质量为1或更低；在最后一次采访中，30%的人不确定，34%的人认为LE为1年或更短。在患者死亡后30天内接受采访的人中，31%的患者和52%的护理人员认为LE为1年或更短。患者对LE的估计并没有因诊断不同而不同。结论：随着时间的推移，预后意识几乎没有变化。即使在接近死亡的时候，很大一部分患者和护理人员也不确定预后，很少有人认为患者的预期寿命有限。患者是否应该知道他们的预后是一个积极争论的主题；预后误解的持续存在表明，对预后的认识可能很难改变。
Purpose: To examine changes in patients' and caregivers' understanding of prognosis with progression of the patient's illness.Subjects and methods: Community-dwelling persons 60 years: of age and older who were seriously ill with cancer, congestive heart failure, or chronic obstructive pulmonary disease and their caregivers were interviewed every 4 months and more frequently with a decline in the patient's status for up to one year. We examined responses to, "If you had to take a guess, how long do you think that (you/the patient) might have to live?" at baseline and at the interview closest to death.Results: Among 218 patients, 87 died within I year. At their initial interview 46% were uncertain about their life expectancy (LE) and 9% believed LE was 1 year or less; at their final interview, 55% were uncertain and 17% believed LE was 1 year or less. At the caregiver's initial interview, 29% were uncertain about the patient's LE and 20% believed LE was 1 or less; at their final interview, 30% were uncertain and 34% believed LE was 1 year or less. Among those interviewed within 30 days of the patient's death, 31% of patients and 52% of caregivers believed LE was 1 year or less. Patients' estimates of the LE did not differ according to their diagnosis.Conclusions: There was little change in prognostic awareness over time. Even close to death, a large proportion of patients and caregivers were uncertain about prognosis, and few believed the patient had a limited life expectancy. Whether or not patients should know their prognosis is the subject of active debate; the persistence of prognostic misperception suggests that prognostic awareness may be difficult to change.