Family Relationships and Advance Care Planning: Do Supportive and Critical Relations Encourage or Hinder Planning?
Family Relationships and Advance Care Planning: Do Supportive and Critical Relations Encourage or Hinder Planning?
复制标题
DOI：
10.1093/geronb/gbs161
复制
发表时间：
2013-03-01
影响因子：
6.2
通讯作者：
Moorman, Sara
中科院分区：
文献类型：
--
作者：
Boerner, Kathrin;Carr, Deborah;Moorman, Sara
预先护理计划（ACP）的有效性可能取决于家庭成员对患者偏好的理解。然而，据我们所知，没有研究探讨家庭关系动态和ACP之间的关系。ACP包括生前遗嘱、医疗保健持久授权书（DPAHC）预约和讨论。我们评估了家庭关系的三个方面——一般家庭功能、配偶的支持和批评、子女的支持和批评——对总体ACP和特定DPAHC指定的影响。使用多项逻辑回归模型和293名老年人样本数据，我们估计了家庭关系质量对完成ACP和指定配偶或成年子女为DPAHC的可能性的影响。分析控制了人口统计学和健康特征。更好的整体家庭功能增加了ACP的几率。较高水平的配偶支持增加了举行非正式讨论的几率，而配偶批评则降低了将配偶称为DPAHC的几率。来自儿童的批评和情感支持都增加了孩子被命名为DPAHC的几率。家庭动态以复杂的方式影响ACP，在患者及其家属讨论临终关怀和指定DPAHC时应考虑到这一点。
The effectiveness of advance care planning (ACP) may depend on family members' understanding of patient preferences. However, we know of no studies that explore the association between family relationship dynamics and ACP. ACP includes a living will, durable power of attorney for health care (DPAHC) appointment, and discussions. We evaluated the effects of three aspects of family relationsugeneral family functioning, support and criticism from spouse, and support and criticism from childrenuon both overall ACP and specific DPAHC designations.Using multinomial logistic regression models and data from a sample of 293 older adults, we estimated the effects of family relationship quality on the likelihood of completing ACP and appointing a spouse or adult child as DPAHC. Analyses controlled for demographic and health characteristics.Better overall family functioning increased the odds of ACP. Higher levels of spousal support increased the odds of holding informal discussions, whereas spousal criticism reduced the odds of naming one's spouse as DPAHC. Both criticism and emotional support from children increased the odds that a child was named as DPAHC.Family dynamics affect ACP in complex ways and should be considered when patients and their families discuss end-of-life care and make DPAHC designations.