A decision aid for long-term tube feeding in cognitively impaired older persons
A decision aid for long-term tube feeding in cognitively impaired older persons
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DOI：
10.1046/j.1532-5415.2001.4930313.x
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发表时间：
2001-03-01
影响因子：
6.3
通讯作者：
O'Connor, AM
中科院分区：
文献类型：
--
作者：
Mitchell, SL;Tetroe, J;O'Connor, AM
目的：描述认知障碍老年人长期管饲辅助决策系统的开发和评价。设计：前后对照研究。地点：加拿大渥太华的急诊医院。参与者：代替15名65岁及以上考虑放置经皮内窥镜胃造口管的认知障碍住院患者的决策者。测量方法：采用问卷调查的方式比较替代决策者在接触辅助决策工具前后对饲管放置的认知、决策冲突和倾向。还评估了决策援助的可接受性。结果：使用辅助决策工具后，替代决策者对长期管饲的认知显著提高（P = 0.004），决策冲突显著减少（P = 0.004）。对于那些在基线时不确定自己偏好的人来说，决策辅助对干预倾向的影响最大。所有的替代决策者都认为，尽管在非常困难和情绪化的情况下，决策援助是有用的和可接受的。结论：决策辅助通过减少决策冲突和促进知情且符合个人价值观的决策，改善了认知障碍老年患者长期管饲的决策过程。在临终决定的背景下，开发和评估这些工具面临着特殊的挑战。
OBJECTIVE: To describe the development and evaluation of a decision aid for long-term tube feeding in cognitively impaired older people.DESIGN: Before-and-after study.SETTING: Acute care hospitals in Ottawa, Canada.PARTICIPANTS: Substitute decision makers for 15 cognitively impaired inpatients 65 years and older being considered for placement of a percutaneous endoscopic gastrostomy tube.MEASUREMENTS: Questionnaires were used to compare the substitute decision makers' knowledge, decisional conflict, and predisposition regarding feeding tube placement before and after exposure to the decision aid. The acceptability of the decision aid was also assessed.RESULTS: Substitute decision makers significantly increased their knowledge (P = .004) and decreased their decisional conflict (P = .004) regarding long-term tube feeding after using the decision aid. The impact of the decision aid on predisposition toward the intervention was greatest for those who were unsure of their preferences at baseline. All substitute decision makers found the decision aid helpful and acceptable despite very difficult and emotional circumstances.CONCLUSIONS: A decision aid improves the decisionmaking process for long-term tube feeding in cognitively impaired older patients by decreasing decisional conflict and by promoting decisions that are informed and consistent with personal values. There are particular challenges for developing and evaluating these tools in the context of end-of-life decisions.