Measuring and improving the quality of dying and death
Measuring and improving the quality of dying and death
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DOI：
10.7326/0003-4819-139-5_part_2-200309021-00006
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发表时间：
2003-09-02
影响因子：
39.2
通讯作者：
McCown, E
中科院分区：
文献类型：
--
作者：
Patrick, DL;Curtis, JR;McCown, E
改善临终体验是成功老龄化的主要挑战。根据病人的意愿，在可接受的专业和道德标准范围内合理地避免不适的死亡是高质量的死亡。作者开发了一个31项的测量死亡和死亡的质量，并将其应用于社区样本和临终关怀登记的样本。死亡质量和死亡仪器的评分以及感知护理质量的测量从患者死后的亲人那里收集。从所有提供者和医生那里获得的护理质量的总体评分越高，死亡和死亡的质量就越高。在社区研究中，病人的症状被控制得有多好，在临终关怀研究中，病人的愿望被遵循得有多好，治疗方法被解释得有多好，这些都与高质量的死亡有关。临终研究面临的主要挑战包括招募具有代表性的人群样本，因为患者和亲人普遍不愿在生命结束时参与研究；不同报告者死后评价的重要差异；亲人不愿在死后对濒死经历作出负面评价；以及死亡体验的高度个体化和动态性。克服这些挑战对于在美国文化和医疗环境中寻找高质量死亡的社会、组织和个人决定因素是非常重要的。
Improving end-of-life experience is a major challenge to successful aging. Deaths that are reasonably free of discomfort, in accordance with patients' wishes, and within acceptable professional and ethical standards are high-quality deaths. The authors developed a 31-item measure of the quality of dying and death and applied it in a community sample and a sample of hospice enrollees. Scores on the Quality of Dying and Death Instrument and measures of perceived quality of care were collected from patients' loved ones after death. Higher overall after-death ratings of the quality of care received from all providers and from physicians were associated with higher-quality dying and death. How well patients' symptoms were controlled in the community study and how well wishes were followed and treatments were explained in the hospice study were associated with higher-quality dying.Major challenges to end-of-life research include recruiting representative population samples, given widespread reluctance of patients and loved ones to participate in research at the end of life; important variation in evaluations among different reporters after death; reluctance of loved ones to assign negative evaluations to dying experiences after death; and the highly individual and dynamic nature of dying experiences. Overcoming these challenges is of great importance in the search for the social, organizational, and individual determinants of high-quality dying in the U.S. cultural and health care context.