Effect of a disease-specific planning intervention on surrogate understanding of patient goals for future medical treatment.
Effect of a disease-specific planning intervention on surrogate understanding of patient goals for future medical treatment.
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DOI：
10.1111/j.1532-5415.2010.02760.x
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发表时间：
2010-07
影响因子：
6.3
通讯作者：
Brown RL
中科院分区：
文献类型：
--
作者：
Kirchhoff KT;Hammes BJ;Kehl KA;Briggs LA;Brown RL
患有致命疾病的患者及其家人在生命的最后几年面临复杂的治疗决策。代理人通常不清楚患者未来医疗的目标。确定特定疾病的规划过程是否可以提高对此类患者未来医疗目标的替代理解。 2004年1月1日至2007年7月31日期间，在威斯康星州3个城市的大型社区或大学卫生系统的6个门诊诊所中进行了一项多中心随机对照试验。受试者是患有慢性充血性心力衰竭或慢性肾病的患者及其代理决策者。参与者必须是年满 18 岁、有能力、会说英语的成年人。训练有素的卫生专业人员进行了结构化、以患者为中心的访谈，旨在促进知情决策，并完成一份文件，阐明患者在四种特定疾病的健康结果情况方面的目标以及授予代理人的决策自由度。替代理解患者在四种预期的、特定于疾病的结果情况下的护理目标以及决策中的替代自由度。三百一十三对患者-代理人完成了这项研究。根据 Kappa (κ) 分数以及在所有四种情况下和纬度上的测量，干预组替代者对患者目标的理解程度显着高于对照组替代者。干预组κ评分范围为0.61至0.78，而对照组κ评分范围为0.07至0.28。干预组的代理人比对照组的代理人对患者目标和偏好有更好的理解。这一发现是确保患者护理目标得到了解和尊重的第一步。
Patients with life-limiting illnesses, and their families, struggle with complex treatment decisions as these patients approach the last few years of life. Surrogates often do not clearly understand the patient's goals for future medical treatments. To determine if a disease-specific planning process can improve surrogate understanding of such patient goals for future, medical treatments. A multisite randomized controlled trial conducted between January 1, 2004 and July 31, 2007 in 6 outpatient clinics of large community or university health systems in 3 Wisconsin cities. Subjects were patients with either chronic congestive heart failure or chronic renal disease and their surrogate decision makers. Participants had to be competent, English-speaking adults at least 18 years of age. Trained health professionals conducted a structured, patient-centered interview intended to promote informed decision making and to result in the completion of a document clarifying the goals of the patient with regard to four disease-specific health outcome situations and to the degree of decision-making latitude granted to the surrogate. Surrogate understanding of patient goals for care with regard to four expected, disease-specific outcomes situations and of the degree of surrogate latitude in decision making. Three hundred thirteen patient-surrogate pairs completed the study. As measured by Kappa (κ) scores and in all four situations and in the degree of latitude, intervention group surrogates demonstrated a significantly higher degree of understanding of patient goals than control group surrogates. Intervention group κ scores ranged from 0.61 to 0.78, while control group κ scores ranged from 0.07 to 0.28. Surrogates in the intervention group had a significantly better understanding of patient goals and preferences than surrogates in the control group. This finding is the first step toward ensuring that patient goals for care are known and honored.
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影响因子：
3
作者：
Song, MK;Kirchhoff, KT;Hammes, B
通讯作者：
Hammes, B
影响因子：
1.5
作者：
MatheisKraft, C;Roberto, KA
通讯作者：
Roberto, KA
影响因子：
--
作者：
Hammes, BJ;Rooney, BL
通讯作者：
Rooney, BL
影响因子：
2.8
作者：
Briggs, Linda
通讯作者：
Briggs, Linda
影响因子：
--
作者：
Ditto, PH;Danks, JH;Zyzanski, S
通讯作者：
Zyzanski, S