Health Services Research & Development Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, USA; Baylor College of Medicine, Department of Medicine, Section of Geriatrics, Houston, USA.
Geriatric Research Education Clinical Center, NF/SGVHS, Department of Medicine, University of Florida College of Medicine, Gainesville, USA.
Patient Educ Couns. 2014 Mar;94(3):334-41. doi: 10.1016/j.pec.2013.10.013. Epub 2013 Nov 19.
To describe self-reported decision-making styles and associated pathways through end-of-life (EOL) decision-making for African-American, Caucasian, and Hispanic seriously ill male Veterans, and to examine potential relationships of race/ethnicity on these styles.
Forty-four African American, White, and Hispanic male Veterans with advanced serious illnesses participated in 8 racially/ethnically homogenous focus groups. Transcripts were qualitatively analyzed to identify major themes, with particular attention to themes that might be unique to each of the racial/ethnic groups.
Patients described two main decision-making styles, deciding for oneself and letting others decide, leading to five variants that we labeled Autonomists, Altruists, Authorizers, Absolute Trusters, and Avoiders. These variants, with exception of avoiders (not found among White patients), were found across all racial/ethnic groups. The variants suggested different 'implementation strategies', i.e., how clear patients made decisions and whether or not they then effectively communicated them.
These identified decision-making styles and variants generate strategies for clinicians to better address individualized advance care planning.
Physicians should elicit seriously ill patients' decision-making styles and consider potential implementation strategies these styles may generate, thus tailoring individualized recommendations to assist patients in their advance care planning. Patient-centered EOL decision-making can ensure that patient preferences are upheld.
描述非裔美国、白人和西班牙裔重病男性退伍军人在临终决策方面的自我报告决策风格以及相关途径，并探讨种族/民族对这些风格的潜在影响。
44 名患有晚期严重疾病的非裔美国、白人和西班牙裔男性退伍军人参加了 8 个种族/民族同质的焦点小组。对转录本进行了定性分析，以确定主要主题，特别关注可能每个种族/民族群体特有的主题。
患者描述了两种主要的决策风格，即自我决策和让他人决策，从而产生了我们称之为自主者、利他主义者、授权者、绝对信任者和回避者的五种变体。除了回避者（在白人患者中未发现）外，这些变体在所有种族/民族群体中都存在。这些变体表明了不同的“实施策略”，即患者如何明确做出决策，以及他们是否有效地传达了这些决策。
这些确定的决策风格和变体为临床医生提供了更好地解决个体化预先护理计划的策略。
医生应该了解重病患者的决策风格，并考虑这些风格可能产生的潜在实施策略，从而为患者提供个性化的建议，以帮助他们进行预先护理计划。以患者为中心的临终决策可以确保患者的偏好得到维护。
