Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, The Netherlands; Proteion Thuis, Horn, The Netherlands; CAPHRI, Maastricht University Medical Centre+, Maastricht University, Maastricht, The Netherlands.
Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, The Netherlands.
Chest. 2012 May;141(5):1251-1259. doi: 10.1378/chest.11-1472. Epub 2011 Oct 20.
For physicians discussing advance care planning with patients with life-limiting illness, it is important to understand the stability of the patients' preferences for life-sustaining treatments and the factors that predict a change in preferences. Our objectives were to investigate 1-year stability of preferences regarding CPR and mechanical ventilation (MV) for outpatients with advanced COPD, chronic heart failure (CHF), or chronic renal failure (CRF) and to identify predictors of changes in preferences.
In this study, 265 clinically stable outpatients with advanced COPD, CHF, or CRF were visited at baseline and every 4 months for 1 year to assess preferences regarding CPR and MV in their current health status. Generalized estimating equations were used to examine the association between change in life-sustaining treatment preferences and several potential predictors, including changes in comorbidities, hospital admissions, generic health status, care dependency, mobility, and symptoms of anxiety or depression.
The 1-year follow-up period was completed by 77.7% of the patients. Preferences regarding CPR or MV changed in 38.3% of the patients during the follow-up period. Changes over time in generic health status, mobility, symptoms of anxiety and depression, and marital status were associated with changes in life-sustaining treatment preferences.
More than one-third of outpatients with advanced COPD, CHF, or CRF change their preferences regarding CPR and/or MV at least once during 1 year. Regular reevaluation of advance care planning is necessary, in particular when patients experience a change in health status, mobility, symptoms of anxiety or depression, or marital status.
Netherlands National Trial Register; No.: NTR 1552; URL: http://www.trialregister.nl.
对于讨论临终关怀计划的医生来说，了解患者对维持生命治疗的偏好的稳定性以及预测偏好变化的因素非常重要。我们的目的是调查患有晚期 COPD、慢性心力衰竭（CHF）或慢性肾衰竭（CRF）的门诊患者对心肺复苏（CPR）和机械通气（MV）的偏好 1 年稳定性，并确定偏好变化的预测因素。
在这项研究中，265 名临床稳定的晚期 COPD、CHF 或 CRF 门诊患者在基线和 1 年内每 4 个月接受一次访问，以评估他们在当前健康状况下对 CPR 和 MV 的偏好。广义估计方程用于检查生活维持治疗偏好变化与几个潜在预测因素之间的关联，包括合并症、住院、一般健康状况、护理依赖、移动性和焦虑或抑郁症状的变化。
77.7%的患者完成了 1 年的随访期。在随访期间，38.3%的患者对 CPR 或 MV 的偏好发生了变化。一般健康状况、移动性、焦虑和抑郁症状以及婚姻状况随时间的变化与维持生命治疗偏好的变化有关。
超过三分之一的晚期 COPD、CHF 或 CRF 门诊患者在 1 年内至少改变了一次对 CPR 和/或 MV 的偏好。需要定期重新评估预先护理计划，特别是当患者的健康状况、移动性、焦虑或抑郁症状或婚姻状况发生变化时。
荷兰国家试验注册处；编号：NTR 1552；网址：http://www.trialregister.nl。
