Jewish Home Lifecare, Research Institute on Aging, New York, NY 10025, USA.
J Gerontol B Psychol Sci Soc Sci. 2013 Mar;68(2):246-56. doi: 10.1093/geronb/gbs161. Epub 2013 Jan 3.
The effectiveness of advance care planning (ACP) may depend on family members' understanding of patient preferences. However, we know of no studies that explore the association between family relationship dynamics and ACP. ACP includes a living will, durable power of attorney for health care (DPAHC) appointment, and discussions. We evaluated the effects of three aspects of family relations--general family functioning, support and criticism from spouse, and support and criticism from children--on both overall ACP and specific DPAHC designations.
Using multinomial logistic regression models and data from a sample of 293 older adults, we estimated the effects of family relationship quality on the likelihood of completing ACP and appointing a spouse or adult child as DPAHC. Analyses controlled for demographic and health characteristics.
Better overall family functioning increased the odds of ACP. Higher levels of spousal support increased the odds of holding informal discussions, whereas spousal criticism reduced the odds of naming one's spouse as DPAHC. Both criticism and emotional support from children increased the odds that a child was named as DPAHC.
Family dynamics affect ACP in complex ways and should be considered when patients and their families discuss end-of-life care and make DPAHC designations.
预先医疗指示（ACP）的有效性可能取决于家属对患者意愿的理解。但是，我们不知道有任何研究探讨家庭关系动态与 ACP 之间的关系。ACP 包括生前预嘱、医疗保健持久授权书（DPAHC）任命和讨论。我们评估了家庭关系的三个方面——一般家庭功能、配偶的支持和批评、以及子女的支持和批评——对整体 ACP 和特定 DPAHC 指定的影响。
使用多项逻辑回归模型和 293 名老年人样本的数据，我们估计了家庭关系质量对完成 ACP 和指定配偶或成年子女为 DPAHC 的可能性的影响。分析控制了人口统计学和健康特征。
更好的整体家庭功能增加了 ACP 的可能性。配偶的支持度越高，进行非正式讨论的可能性就越大，而配偶的批评则降低了指定配偶为 DPAHC 的可能性。来自子女的批评和情感支持都会增加子女被指定为 DPAHC 的可能性。
家庭动态以复杂的方式影响 ACP，在患者及其家属讨论临终关怀和指定 DPAHC 时应考虑这些因素。
