Valuing the outcomes of treatment - Do patients and their caregivers agree?
Valuing the outcomes of treatment - Do patients and their caregivers agree?
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DOI：
10.1001/archinte.163.17.2073
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发表时间：
2003-09-22
影响因子：
--
通讯作者：
Towle, VR
中科院分区：
文献类型：
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作者：
Fried, TR;Bradley, EH;Towle, VR
背景：治疗结果是患者治疗偏好的重要决定因素。虽然研究已经检查了如何以及代理同意与患者的偏好，具体的治疗干预措施，协议的评估健康状况作为treatment outcomes is unknown.Methods：横断面队列研究，包括inhome访谈193人60岁或以上，患有癌症，充血性心力衰竭，慢性阻塞性肺病和他们的照顾者。患者被问到，面对疾病的恶化，他们是否会发现一系列的健康状态作为治疗的结果是可以接受的（“不可接受”的评级意味着他们宁愿死也不接受治疗）。照顾者被问到他们是否会发现这些国家接受patient.Results：有80%或更高的协议，健康状况的整体评价是可以接受的（目前的健康状况，轻度记忆障碍，轻度疼痛，或其他症状）或不可接受的（昏迷）。有58%至62%的一致性（kappa = 0。10-0. 25)身体或认知障碍更严重的国家。当发生分歧时，照顾者更有可能将状态评为可接受的。有61%至65%的协议（kappa = 0.20-0.28）关于严重疼痛或其他症状的状态。当发生分歧时，照顾者和患者同样有可能率的状态accepted.Conclusions：病人照顾者协议的可接受性的功能或认知障碍，严重的疼痛，或其他症状的健康状态是穷人。照顾者基于治疗结果的考虑做出替代决定可能不能有效地代表患者的偏好。
Background: Treatment outcomes are an important determinant of patients' treatment preferences. Although studies have examined how well surrogates agree with patients' preferences for specific treatment interventions, agreement regarding the valuation of health states as treatment outcomes is unknown.Methods: Cross-sectional cohort study consisting of inhome interviews with 193 persons 60 years or older and seriously ill with cancer, congestive heart failure, or chronic obstructive pulmonary disease and their caregivers. Patients were asked whether, facing an exacerbation of illness, they would find a series of health states acceptable as a result of treatment (a rating of "unacceptable" meant they would prefer to die than to receive treatment). Caregivers were asked whether they would find these states acceptable for the patient.Results: There was 80% or greater agreement for health states that were overall rated either acceptable (current health, mild memory impairment, mild pain, or other symptoms) or unacceptable (coma). There was 58% to 62% agreement (kappa = 0. 10-0. 25) about states with more severe physical or cognitive impairment. When disagreement occurred, caregivers were more likely to rate the state as acceptable. There was 61% to 65% agreement (kappa = 0.20-0.28) about states with severe pain or other symptoms. When disagreement occurred, caregivers and patients were equally likely to rate the state as acceptable.Conclusions: Patient-caregiver agreement about the acceptability of health states with functional or cognitive impairment, severe pain, or other symptoms was poor. Caregivers making surrogate decisions based on considerations of treatment outcomes may not effectively represent patients' preferences.