Treatment Goals at the End of Life

描述(申请人提供)：符合绝症患者的喜好 对提供高质量的临终关怀来说，人是必不可少的。虽然 许多干预研究都基于这样一个假设，即绝症患者 患者渴望较少的技术密集型护理，这一假设并没有 已经做了很好的研究。作为对治疗偏好的第一次纵向研究 对于老年绝症患者，本研究的总体目标是 检查患者及其家属的偏好在 随着患者病情的发展，疾病的谱系。其主要目的是 确定初步诊断、健康状况和医疗保健的效果 利用患者及其家属的喜好。 拟议的研究将涉及226名身患绝症的老年人和一个家庭。 成员。他们将每四个月在家中接受一次采访，如果是医学上的话 病情稳定，如果病情恶化，每月都会出现一次。在……里面 与以前的研究不同，以前的研究主要是在 在具体的治疗偏好方面，本研究将以患者为中心 偏好的衡量标准。来自定性研究，这些可靠和 有效的工具根据治疗目标衡量偏好。这个 疾病诊断、健康状况(功能状况、 症状、自评健康)、医疗保健利用率(住院、 重症监护病房入院、疗养院入院)和对 疾病预后和喜好将使用纵向检查 重复测量分析。 对患者及家属治疗目标的了解 晚期疾病的病程对新系统的发展是必不可少的 照顾临终病人。此外，对这一现象的描述 患者在治疗目标方面的偏好，而不是他们的 具体的治疗偏好为未来的干预提供了基础 旨在改善医患沟通。这项研究利用了一个 独特的社区居住老年人队列，被确定为有 以客观标准判断是绝症。

DESCRIPTION (provided by applicant): Meeting the preferences of terminally ill persons is essential to the provision of quality end-of-life care. Although many intervention studies have been based on the assumption that terminally ill patients desire less technologically intensive care, this assumption has not been well studied. As the first longitudinal study of the treatment preferences of older terminally ill persons, the overall objective of this study is to examine changes in the preferences of both patients and their families across a spectrum of diseases as the patient's illness progresses. The primary aim is to determine the effect of primary diagnosis, health status, and healthcare utilization on the preferences of patients and their families. The proposed study will involve 226 terminally ill older persons and a family member. They will be interviewed in their homes every four months if medically stable, and as frequently as every month if the illness is progressing. In contrast to previous studies, which have primarily measured preferences in terms of specific treatment preferences, this study will use patient-centered measures of preferences. Derived from qualitative research, these reliable and valid instruments measure preference in terms of treatment goals. The relationship between disease diagnosis, health status (functional status, symptoms, self-rated health), healthcare utilization (hospitalization, intensive care unit admissions, nursing home admissions), and understanding of the illness prognosis and preferences will be examined using longitudinal repeated measures analysis. The understanding of patients' and family members' treatment goals over the course of a terminal illness is essential to the development of new systems of care for terminally ill patients. Furthermore, the characterization of patients' preferences in terms of their treatment goals instead of their specific treatment preferences provides the basis for future interventions designed to improve physician-patient communication. This study utilizes a unique cohort of community-dwelling older persons identified as having a terminal illness by objective criteria.