Video decision support tool for advance care planning in dementia: randomised controlled trial
Video decision support tool for advance care planning in dementia: randomised controlled trial
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DOI：
10.1136/bmj.b2159
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发表时间：
2009-05-28
影响因子：
105.7
通讯作者：
Mitchell, Susan L.
中科院分区：
文献类型：
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作者：
Volandes, Angelo E.;Paasche-Orlow, Michael K.;Mitchell, Susan L.
目的评估视频决策支持工具对老年痴呆患者未来医疗护理偏好的影响，研究设计：随机对照试验，于2007年9月1日至2008年5月30日进行。（两个老年医学和两个成人医学）附属于波士顿的三个学术医疗中心。（>= 65岁）居住在社区，以前在其中一个诊所预约。平均年龄为75岁，58%为女性。干预单独口头叙述（n=106）或与视频决策支持工具（n=94）。主要结果测量首选的护理目标：延长生命的护理（心肺复苏，机械通气），有限的护理（入院，抗生素，但不是心肺复苏），或舒适护理（治疗仅缓解症状）。六周后的偏好。分析的主要类别是在各组中的参与者谁喜欢舒适care.Results的比例的差异在接受口头叙述的参与者中，68（64%）选择舒适护理，20（19%）选择有限的护理，15（14%）选择延长生命的护理，和三个（3%）是不确定的。在视频组中，81人（86%）选择舒适护理，8人（9%）选择有限护理，4人（4%）选择延长生命护理，1人（1%）不确定（chi（2）=13.0，df=3，P=0.003）。在所有参与者中，与选择舒适护理的可能性更大相关的因素是大学毕业生或更高学历、良好或更好的健康状况、更高的健康素养、白色种族和随机分配到视频组。在多变量分析中，视频组的参与者比语言组的参与者更喜欢舒适护理（调整后的比值比3.9，95%置信区间1.8至8.6）。参与者在六周后再次接受采访。在94/106（89%）的参与者重新采访的口头组，27（29%）改变了他们的喜好（kappa=0.35）。在84/94（89%）的参与者中，有5（6%）人改变了他们的偏好（kappa=0.79）（P
Objective To evaluate the effect of a video decision support tool on the preferences for future medical care in older people if they develop advanced dementia, and the stability of those preferences after six weeks.Design Randomised controlled trial conducted between 1 September 2007 and 30 May 2008.Setting Four primary care clinics (two geriatric and two adult medicine) affiliated with three academic medical centres in Boston.Participants Convenience sample of 200 older people (>= 65 years) living in the community with previously scheduled appointments at one of the clinics. Mean age was 75 and 58% were women.Intervention Verbal narrative alone (n=106) or with a video decision support tool (n=94).Main outcome measures Preferred goal of care: life prolonging care (cardiopulmonary resuscitation, mechanical ventilation), limited care (admission to hospital, antibiotics, but not cardiopulmonary resuscitation), or comfort care (treatment only to relieve symptoms). Preferences after six weeks. The principal category for analysis was the difference in proportions of participants in each group who preferred comfort care.Results Among participants receiving the verbal narrative alone, 68 (64%) chose comfort care, 20 (19%) chose limited care, 15 (14%) chose life prolonging care, and three (3%) were uncertain. In the video group, 81 (86%) chose comfort care, eight (9%) chose limited care, four (4%) chose life prolonging care, and one (1%) was uncertain (chi(2)=13.0, df=3, P=0.003). Among all participants the factors associated with a greater likelihood of opting for comfort care were being a college graduate or higher, good or better health status, greater health literacy, white race, and randomisation to the video arm. In multivariable analysis, participants in the video group were more likely to prefer comfort care than those in the verbal group (adjusted odds ratio 3.9, 95% confidence interval 1.8 to 8.6). Participants were re-interviewed after six weeks. Among the 94/106 (89%) participants re-interviewed in the verbal group, 27 (29%) changed their preferences (kappa=0.35). Among the 84/94 (89%) participants re-interviewed in the video group, five (6%) changed their preferences (kappa=0.79) (P