Sutton Eileen J, Coast Joanna
1School of Oral and Dental Sciences, University of Bristol, Bristol, UK.
Palliat Med. 2014 Feb;28(2):151-7. doi: 10.1177/0269216313489368. Epub 2013 May 22.
An imperative to assess the economic impact of care at the end of life is emerging in response to national policy developments in a number of settings. Current focus on health benefits in economic evaluation may not appropriately capture benefits of interventions at the end of life. No instruments are available for measuring such benefits for economic evaluation of end-of-life care.
To develop a descriptive system for a measure for use in economic evaluation of end-of-life care.
An initial phase of in-depth interviews was conducted to develop conceptual attributes for inclusion in a measure; a second phase of semi-structured repeat interviews with a subsample of informants was carried out to clarify and confirm the final set of attributes and to develop meaningful wording for a measure.
SETTING/PARTICIPANTS: In total, 23 older people from three groups across the dying trajectory: older people (1) within the general population, (2) living in residential care and (3) receiving palliative care.
Interviews suggested that the important domains to include within this framework from the perspective of those approaching the end-of-life are choice/having a say in decision-making, love and affection/being with people who care, freedom from physical suffering, freedom from emotional suffering, dignity and self-respect, support, and preparation. A full descriptive system comprising seven questions, each representing one attribute, was developed.
Economic evaluation should reflect the broader benefits of end-of-life care. Although the supportive care measure developed here requires validation and valuation, it provides a substantial step forward in appropriate economic evaluation of end-of-life care.
鉴于一些国家政策的发展，评估临终护理的经济影响已成为当务之急。目前经济评估中对健康效益的关注可能无法恰当地体现临终干预措施的效益。尚无用于衡量临终护理经济评估中此类效益的工具。
开发一种用于临终护理经济评估的描述性测量系统。
开展了第一阶段的深度访谈，以确定纳入测量系统的概念性属性；对部分信息提供者进行了第二阶段的半结构化重复访谈，以澄清和确认最终的属性集，并为测量系统拟定有意义的措辞。
背景/参与者：共有来自临终轨迹三个阶段的23名老年人参与：（1）普通人群中的老年人，（2）住在养老院的老年人，（3）接受姑息治疗的老年人。
访谈表明，从临终者的角度来看，该框架应纳入的重要领域包括：选择/在决策中有发言权、爱与情感/与关心自己的人在一起、免受身体痛苦、免受情感痛苦、尊严和自尊、支持以及准备。开发了一个完整的描述性系统，包括七个问题，每个问题代表一个属性。
经济评估应反映临终护理的更广泛效益。尽管此处开发的支持性护理测量系统需要进行验证和估值，但它在临终护理的适当经济评估方面向前迈出了重要一步。
