Discordance between patients' stated values and treatment preferences for end-of-life care: results of a multicentre survey
Discordance between patients' stated values and treatment preferences for end-of-life care: results of a multicentre survey
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DOI：
10.1136/bmjspcare-2015-001056
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发表时间：
2017-09-01
影响因子：
2.7
通讯作者：
Day, Andrew G.
中科院分区：
文献类型：
--
作者：
Heyland, Daren K.;Heyland, Rebecca;Day, Andrew G.
背景 使用生命维持系统的医嘱应考虑患者的价值观和治疗偏好。本研究的目的是探讨患者（或其家庭成员）陈述的价值观的内部一致性，以及这些价值观与表达的偏好之间的关系。方法我们在加拿大的 12 家急症护理医院进行了一项前瞻性研究。我们对老年患者及其家人进行了问卷调查，了解他们与临终 (EOL) 护理相关的价值观、治疗偏好和决策冲突。结果 在 513 名患者和 366 名家庭成员中，278 名患者 (54%) 和 225 名家庭成员 (61%) 同意参与。参与者最重要的价值观是舒适并尽可能少受苦，有更多时间与家人在一起，避免与机器和管道相连，以及不延长死亡时间。最不重要的规定价值是保护生命。根据预先设定的各种测量值之间的预期关联，参与者表达的价值陈述存在不一致之处。除少数例外，参与者表达的价值观与预期的相应治疗偏好无关。在 109 名 (40%) 名患者和 95 名 (42%) 家庭成员做出关于使用生命支持的决定时，68 名 (56%) 名患者和 60 名 (59%) 家庭成员存在决策冲突。 结论 EOL 时有关医疗治疗的决策不充分。为了减少决策冲突，患者及其家人需要更多支持来澄清他们的价值观，并确保他们的偏好基于对他们的疾病和治疗方案的充分了解。
Background Medical orders for the use of life-supports should be informed by patients' values and treatment preferences. The purpose of this study was to explore the internal consistency of patients' (or their family members') stated values, and the relationship between these values and expressed preferences.Methods We conducted a prospective study in 12 acute care hospitals in Canada. We administered a questionnaire to elderly patients and their family members about their values related to end-of-life (EOL) care, treatment preferences and decisional conflict.Results Of 513 patients and 366 family members approached, 278 patients (54%) and 225 family members (61%) consented to participate. Participants' most important stated values were to be comfortable and suffer as little as possible, to have more time with family, to avoid being attached to machines and tubes and that death not be prolonged. The least important stated value was that life be preserved. Based on prespecified expected associations between the various values measured, there were inconsistencies in participants' expressed value statements. With few exceptions, participants' expressed values were not associated with expected corresponding treatment preferences. Of the 109 (40%) patients and 95 (42%) family members who had made decisions about use of life-supports, 68 (56%) patients and 60 (59%) family members had decisional conflict.Conclusions Decision-making regarding medical treatments at the EOL is inadequate. To reduce decisional conflict, patients and their families need more support to clarify their values and ensure that their preferences are grounded in adequate understanding of their illness and treatment options.