Treatment Goals at the End of Life

描述（由申请人提供）：满足绝症患者的偏好 对提供高质量的临终关怀至关重要。虽然 许多干预研究都是基于这样的假设， 患者希望技术密集型护理较少，这一假设并没有 被好好研究过了。作为第一个纵向研究的治疗偏好 老年绝症患者，这项研究的总体目标是 检查患者及其家属在不同时期的偏好变化 随着病人病情的发展，主要目的是 确定初步诊断、健康状况和医疗保健的影响 根据患者及其家属的喜好使用。 这项拟议的研究将涉及226名身患绝症的老年人和一个家庭。 会员是否他们将每四个月在家中接受一次采访， 病情稳定，如果病情进展，每月一次。在 与以前的研究相反，以前的研究主要测量 就具体治疗偏好而言，本研究将采用以患者为中心的 优惠措施。从定性研究中得出，这些可靠和 有效的工具衡量治疗目标方面的偏好。的 疾病诊断，健康状态（功能状态， 症状，自评健康），保健利用（住院， 重症监护病房入院，疗养院入院），并了解 疾病预后和偏好将使用纵向 重复测量分析。 患者和家属对治疗目标的理解 一个绝症的过程是必不可少的新系统的发展， 照顾绝症病人。此外， 患者在治疗目标方面的偏好，而不是 具体的治疗偏好为未来的干预措施提供了基础 旨在改善医患沟通。这项研究利用了一个 社区居住老年人的独特群体， 根据客观标准的晚期疾病。

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.