Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA.
J Gen Intern Med. 2012 May;27(5):568-75. doi: 10.1007/s11606-011-1933-0. Epub 2011 Nov 30.
Prognosis is critical in individualizing care for older adults with late life disability. Evidence suggests that preferences for prognostic information may be culturally determined. Yet little is known about the preferences of diverse elders for discussing prognosis.
To determine the preferences for discussing prognosis of a diverse sample of older adults with late-life disability.
DESIGN & PARTICIPANTS: We interviewed 60 older adults with mean age 78 and mean 2.5 Activities of Daily Living dependencies. Participants were recruited from San Francisco's On Lok program, the first Program of All-inclusive Care for the Elderly (PACE). Participants were interviewed in English, Spanish, and Cantonese, and responded to scenarios in which their doctors estimated they had 5 years and 1 year left to live. Open-ended questions explored the reasons for their responses. Results were analyzed qualitatively using grounded theory.
Sixty-five percent of participants wanted to discuss the prognosis if their doctor estimated they had <5 years to live and 75% if the estimate was <1 year. Three themes were prominent among patients who wanted to discuss prognosis: to prepare, to make the most of the life they had left, and to make medical or health-related decisions. Those who preferred not to discuss prognosis described emotional difficulty, the uncertainty of prognosis, or that it would not be useful. Nearly all participants said that doctors should not make assumptions based on race or ethnicity, though differences between ethnic groups emerged.
Most patients in this diverse sample of disabled elders were interested in discussing prognosis, while a substantial minority was not. Among those participants who preferred to discuss prognosis, many said that prognostic information would be important as they made difficult medical and personal decisions in late-life. Clinicians should inquire about preferences for discussing prognosis before sharing prognostic estimates.
预后对于为患有晚期失能的老年人提供个体化护理至关重要。有证据表明，对预后信息的偏好可能是由文化决定的。然而，对于不同老年人对讨论预后的偏好知之甚少。
确定具有晚期失能的不同老年人对讨论预后的偏好。
我们对 60 名平均年龄为 78 岁且平均有 2.5 项日常生活活动依赖的老年患者进行了访谈。参与者是从旧金山的 On Lok 项目（第一个综合老年人护理计划，PACE）招募的。参与者接受了英语、西班牙语和粤语采访，并对他们的医生估计他们还有 5 年和 1 年的生命的情况做出了回应。开放性问题探讨了他们做出回应的原因。使用扎根理论对结果进行了定性分析。
如果他们的医生估计他们的生命不足 5 年，65%的参与者希望讨论预后，如果估计不足 1 年，则 75%的参与者希望讨论预后。有三个主题在希望讨论预后的患者中非常突出：为准备、充分利用他们所剩无几的生命以及做出医疗或健康相关决策。那些不希望讨论预后的患者描述了情绪上的困难、预后的不确定性或预后没有帮助。几乎所有参与者都表示，医生不应根据种族或族裔做出假设，尽管不同种族群体之间存在差异。
在这个多样化的残疾老年人样本中，大多数患者对讨论预后感兴趣，但仍有相当一部分患者不感兴趣。在那些愿意讨论预后的参与者中，许多人表示，在生命晚期做出艰难的医疗和个人决策时，预后信息将非常重要。临床医生在分享预后估计之前应询问讨论预后的偏好。
