Allen Rebecca S, Allen Jessica Y, Hilgeman Michelle M, DeCoster Jamie
Department of Psychology, University of Alabama, Tuscaloosa, Alabama 35487-0348, USA.
J Am Geriatr Soc. 2008 Oct;56(10):1904-9. doi: 10.1111/j.1532-5415.2008.01929.x. Epub 2008 Sep 4.
To examine the effect of enhanced information regarding the risks, benefits, and life-sustaining treatment alternatives on hypothetical medical decisions and decisional conflict in older, community-dwelling Caucasian and African-American adults.
Two-group (enhanced information; no information) between-subjects design.
Community-based dwellings, two assisted living facilities, and one senior citizen center.
Seventy-eight adults (aged 74.5+/-7.18) with a mean Telephone Interview for Cognitive Status--Modified (TICS-m) score of 31.5+/-4.7 were recruited through personal contacts and informational talks held at the recruitment sites.
Measures included the Life Support Preferences/Predictions Questionnaire--modified (LSPQ-m); the Decisional Conflict Scale; and enhanced information, including detailed descriptions of life-sustaining treatment options for each LSPQ-m illness scenario, risks of the treatment, benefits of the treatment, and alternatives for each treatment (called medical information stimuli).
Enhanced information (e.g., medical information stimuli) reduced decisional conflict (P=.049, d=0.47) for hypothetical life-sustaining treatment decisions. A mixed analysis of variance with group and race as between-subjects variables and illness and treatment as within-subjects variables revealed significant main effects of race, illness, and treatment, as well as a significant race-by-illness-by-group interaction (Wilk's lambda=0.923, F(2, 73)=3.05, P=.05, partial eta(2)=0.08). Enhanced information produced different patterns of desire for life-sustaining treatments in African Americans and Caucasians.
Physicians and other healthcare professionals can reduce decisional conflict in patients by providing enhanced information regarding treatment risks, benefits, and alternatives. Such decision aids may provide new information or knowledge and thus reduce desire for treatment in African Americans.
探讨提供有关风险、益处及维持生命治疗替代方案的强化信息，对居住在社区的老年白种人和非裔美国成年人在假设性医疗决策及决策冲突方面的影响。
两组（强化信息组；无信息组）组间设计。
社区住宅、两家辅助生活设施及一家老年中心。
通过在招募地点进行的个人联系和信息交流，招募了78名成年人（年龄74.5±7.18岁），其改良电话认知状态访谈（TICS-m）平均得分为31.5±4.7分。
测量指标包括改良的生命支持偏好/预测问卷（LSPQ-m）；决策冲突量表；以及强化信息，包括针对每个LSPQ-m疾病场景的维持生命治疗方案的详细描述、治疗风险、治疗益处及每种治疗的替代方案（称为医疗信息刺激）。
强化信息（如医疗信息刺激）减少了假设性维持生命治疗决策中的决策冲突（P = 0.049，d = 0.47）。以组和种族作为组间变量、疾病和治疗作为组内变量的混合方差分析显示，种族、疾病和治疗存在显著的主效应，以及显著的种族×疾病×组交互作用（威尔克斯λ = 0.923，F(2, 73) = 3.05，P = 0.05，偏η² = 0.08）。强化信息在非裔美国人和白种人中产生了不同的维持生命治疗愿望模式。
医生和其他医疗保健专业人员可以通过提供有关治疗风险、益处及替代方案的强化信息来减少患者的决策冲突。此类决策辅助工具可能会提供新的信息或知识，从而降低非裔美国人对治疗的愿望。
