Winter Laraine, Parks Susan Mockus
Center for Applied Research on Aging and Health (CARAH), Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
J Palliat Med. 2008 Oct;11(8):1109-14. doi: 10.1089/jpm.2008.0039.
Because many Americans are decisionally incapacitated at the end of life, the last treatment decisions are often made by family proxies. Family discord concerning end-of-life (EOL) care may not only exacerbate a family crisis but also influence treatment decisions. We tested the extent to which family discord would be associated with preferences for types of end-of-life care, predicting that greater discord would be associated with weaker preferences for palliative care and stronger preferences for life-prolonging care.
SETTING/SUBJECTS: Sixty-eight proxy decision makers for elderly relatives were interviewed in their homes over the telephone.
The 35-minute telephone interview assessed preferences for four life-prolonging treatments and for palliative care and included a family discord measure, an EOL values scale, and questions about sociodemographic characteristics.
Repeated-measures analyses of covariance and regression analyses showed that greater family discord was associated with stronger preferences for life-prolonging treatments and weaker preferences for palliative care, independently of EOL values and sociodemographic characteristics.
In counseling patients with life-limiting illnesses and their families, clinicians should explore possible family discord surroundings EOL care. Counseling protocols should be developed and clinicians should be trained in counseling to minimize family conflict.
由于许多美国人在生命末期失去决策能力，最后的治疗决策往往由家庭代理人做出。关于临终关怀的家庭矛盾不仅可能加剧家庭危机，还会影响治疗决策。我们测试了家庭矛盾与临终关怀类型偏好之间的关联程度，预测更大的矛盾将与对姑息治疗的较弱偏好以及对延长生命治疗的较强偏好相关。
设置/对象：通过电话在家中对68位老年亲属的代理决策者进行了访谈。
35分钟的电话访谈评估了对四种延长生命治疗和姑息治疗的偏好，并包括一项家庭矛盾测量、一个临终价值观量表以及关于社会人口学特征的问题。
重复测量协方差分析和回归分析表明，更大的家庭矛盾与对延长生命治疗的更强偏好以及对姑息治疗的较弱偏好相关，这与临终价值观和社会人口学特征无关。
在为患有绝症的患者及其家人提供咨询时，临床医生应探讨围绕临终关怀可能存在的家庭矛盾。应制定咨询方案，并对临床医生进行咨询培训，以尽量减少家庭冲突。
