END OF LIFE PREFERENCES & OUTCOMES: PATIENTS & SPOUSES

生命终结偏好

• 批准号: 6930910
• 负责人: RACHEL A PRUCHNO
• 金额: $ 60.31万
• 依托单位: UNIV OF MED/DENT NJ-SCH OSTEOPATHIC MED
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-09-05 至 2008-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6930910
• 关键词: behavioral /social science research tag; chronic renal failure; clinical research; grief; human subject; interview; preference; spouses; terminal patient care

Proposed is a prospective longitudinal study of: (1) the end of life preferences for treatment held by patients with chronic illness and their spouses; (2) the ways that end of life preference of patients and spouses change over the course of a chronic illness; and (3) the effects that end of life preferences and actual administration of various end of life treatments have on the sense of burden, grief, and mental health of the patient's spouse. The overall goal of the study is to gain better understanding of the preferences for end of life treatment and the effects of such preferences within the contexts of both the marital dyad and the course of chronic disease. Grounded in family stress theory, the central hypotheses to be tested are: (1) Patient and spouse preferences for end of life treatment vary directly as a function of perceptions of quality of patient life and indirectly as a function of the stressors (e.g., physical health and functional ability of the patient) and resources (religious/spiritual, marital relationship, social support) of patients and their spouses; (2) The greater the congruence between patient and spouse regarding end of life preferences, the less the sense of burden the spouse will feel. Reduced burden, in turn, results in better mental health for the spouse; (3) Over the course of disease, as quality of life declines, preferences for treatment will change from those focused on aggressive treatment to those that are more palliative; (4) The greater the degree of spouse congruence regarding preferences for end of life treatment and the greater the extent of congruence between preferences for treatment and actual end of life treatment administered, the less grief will be experienced by the spouse after the death of the patient and the better will be the mental health of the spouse. In order to address these hypotheses, a five-year prospective longitudinal study design is proposed. 325 patients with ESRD and their spouses would be assessed comprehensively at baseline and then briefly at four times (9, 18, 27, 36 months) over the course of the three years. Spouses who become widowed during the observation period would participate in a single post-death interview. Analyses would focus on both cross-sectional and prospective longitudinal relationships using a combination of a regression, structural equation modeling, and categorical data analysis techniques.

提议进行一项前瞻性纵向研究：(1) 慢性病患者治疗的生活偏好及其 配偶； (2)患者及配偶临终偏好的方式 慢性疾病过程中的变化； (3) 结束的影响 生活偏好和各种临终治疗的实际管理 影响患者配偶的负担感、悲伤感和心理健康。 该研究的总体目标是更好地了解 对临终治疗的偏好以及这种偏好的影响 在婚姻二元关系和慢性病病程的背景下。 以家庭压力理论为基础，要检验的中心假设是：（1） 患者和配偶对临终治疗的偏好各不相同 患者生活质量感知的函数，间接作为函数 压力源（例如患者的身体健康和功能能力） 和资源（宗教/精神、婚姻关系、社会支持） 患者及其配偶； (2)患者与患者之间的一致性越大 配偶对于临终的偏好，负担感越小 配偶会感觉到。减轻负担反过来又会带来更好的心理健康 配偶； (3) 在疾病过程中，随着生活质量的下降， 治疗偏好将从那些专注于攻击性的 对那些较为姑息的患者进行治疗； (4) 度数越大 配偶对临终治疗的偏好以及 治疗偏好与实际情况之间的一致性程度更大 进行临终治疗时，患者所经历的悲伤越少 患者去世后配偶的心理健康状况会更好 配偶的。为了解决这些假设，我们进行了一项为期五年的前瞻性研究 提出了纵向研究设计。 325名终末期肾病患者及其配偶 将在基线时进行全面评估，然后分四次进行简要评估 三年期间（9、18、27、36 个月）。配偶成为 观察期内丧偶者将参加单次死亡后 面试。分析将侧重于横截面和前瞻性 结合回归、结构的纵向关系 方程建模和分类数据分析技术。

项目成果

Spouse as health care proxy for dialysis patients: whose preferences matter?

配偶作为透析患者的医疗保健代理：谁的偏好重要？

• DOI: 10.1093/geront/45.6.812
• 发表时间: 2005
• 期刊: The Gerontologist
• 作者: Pruchno,RachelA;LemayJr,EdwardP;Feild,Lucy;Levinsky,NormanG
• 通讯作者: Levinsky,NormanG

The effects of race on patient preferences and spouse substituted judgments.

• DOI: 10.2190/ag.69.1.c
• 发表时间: 2009
• 期刊: International journal of aging & human development
• 影响因子: 2
• 作者: Pruchno R;Cartwright FP;Wilson-Genderson M
• 通讯作者: Wilson-Genderson M

Stability and change in patient preferences and spouse substituted judgments regarding dialysis continuation.

患者偏好和配偶的稳定性和变化取代了关于继续透析的判断。

• DOI: 10.1093/geronb/63.2.s81
• 发表时间: 2008
• 期刊: The journals of gerontology. Series B, Psychological sciences and social sciences
• 作者: Pruchno,RachelA;Rovine,MichaelJ;Cartwright,Francine;Wilson-Genderson,Maureen
• 通讯作者: Wilson-Genderson,Maureen

Effects of marital closeness on the transition from caregiving to widowhood.

• DOI: 10.1080/13607860903046503
• 发表时间: 2009-11
• 期刊: Aging & mental health
• 影响因子: 3.4
• 作者: Pruchno RA;Cartwright FP;Wilson-Genderson M
• 通讯作者: Wilson-Genderson M

Quality of life in end-stage renal disease patients: differences in patient and spouse perceptions.

• DOI: 10.1080/13607860902845558
• 发表时间: 2009-09
• 期刊: Aging & mental health
• 影响因子: 3.4
• 作者: Ferri CV;Pruchno RA
• 通讯作者: Pruchno RA