Einterz Seth F, Gilliam Robin, Lin Feng Chang, McBride J Marvin, Hanson Laura C
Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC; Georgetown University School of Medicine, Washington, DC.
Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC.
J Am Med Dir Assoc. 2014 Apr;15(4):251-5. doi: 10.1016/j.jamda.2013.11.020. Epub 2014 Feb 6.
Decision aids are effective to improve decision-making, yet they are rarely tested in nursing homes (NHs). Study objectives were to (1) examine the feasibility of a goals of care (GOC) decision aid for surrogate decision-makers (SDMs) of persons with dementia; and (2) to test its effect on quality of communication and decision-making.
Pre-post intervention to test a GOC decision aid intervention for SDMs for persons with dementia in NHs. Investigators collected data from reviews of resident health records and interviews with SDMs at baseline and 3-month follow-up.
Two NHs in North Carolina.
Eighteen residents who were over 65 years of age, had moderate to severe dementia on the global deterioration scale (5, 6, or 7), and an English-speaking surrogate decision-maker.
(1) GOC decision aid video viewed by the SDM and (2) a structured care plan meeting between the SDM and interdisciplinary NH team.
Surrogate knowledge, quality of communication with health care providers, surrogate-provider concordance on goals of care, and palliative care domains addressed in the care plan.
Eighty-nine percent of the SDMs thought the decision aid was relevant to their needs. After viewing the video decision aid, SDMs increased the number of correct responses on knowledge-based questions (12.5 vs 14.2; P < .001). At 3 months, they reported improved quality of communication scores (6.1 vs 6.8; P = .01) and improved concordance on primary goal of care with NH team (50% vs 78%; P = .003). The number of palliative care domains addressed in the care plan increased (1.8 vs 4.3; P < .001).
The decision-support intervention piloted in this study was feasible and relevant for surrogate decision-makers of persons with advanced dementia in NHs, and it improved quality of communication between SDM and NH providers. A larger randomized clinical trial is underway to provide further evidence of the effects of this decision aid intervention.
决策辅助工具对改善决策有效，但在养老院（NHs）中很少进行测试。研究目的是：（1）检验针对痴呆症患者替代决策者（SDMs）的照护目标（GOC）决策辅助工具的可行性；（2）测试其对沟通质量和决策的影响。
对NHs中痴呆症患者的SDMs进行GOC决策辅助工具干预的前后对照试验。研究人员在基线和3个月随访时，通过查阅居民健康记录和访谈SDMs来收集数据。
北卡罗来纳州的两家NHs。
18名65岁以上、在总体衰退量表上有中度至重度痴呆（5、6或7级）且有说英语替代决策者的居民。
（1）SDM观看GOC决策辅助工具视频；（2）SDM与NH跨学科团队举行结构化照护计划会议。
替代决策者的知识、与医疗服务提供者的沟通质量、替代决策者与提供者在照护目标上的一致性，以及照护计划中涉及的姑息治疗领域。
89%的SDM认为决策辅助工具与他们的需求相关。观看视频决策辅助工具后，SDM在基于知识的问题上正确回答的数量增加（12.5对14.2；P <.001）。在3个月时，他们报告沟通质量得分有所提高（6.1对6.8；P =.01），并且在与NH团队的主要照护目标上的一致性有所提高（50%对78%；P =.003）。照护计划中涉及的姑息治疗领域数量增加（1.8对4.3；P <.001）。
本研究中试行的决策支持干预措施对NHs中晚期痴呆症患者的替代决策者是可行且相关的，并且改善了SDM与NH提供者之间的沟通质量。一项更大规模的随机临床试验正在进行，以提供该决策辅助工具干预效果的进一步证据。
