Darer Jonathan D, Clarke Deseraé N, Sees Amanda C, Berger Andrea L, Kirchner H Lester, Stametz Rebecca A, Davis Daniel
Center for Clinical Innovation, Geisinger Health System, Danville, Pennsylvania, USA.
Center for Clinical Innovation, Geisinger Health System, Danville, Pennsylvania, USA.
J Pain Symptom Manage. 2015 Sep;50(3):343-349.e6. doi: 10.1016/j.jpainsymman.2015.03.011. Epub 2015 May 15.
With growing emphasis on improving the value of health care, there is increased scrutiny of quality outcomes and high health expenditures during the final months of life.
The purpose of this project is to answer 1) how do next of kin (NOK) perceive the quality of their loved ones' dying and death; 2) are there patient and NOK characteristics that predict lower quality; and 3) are there structural aspects of care associated with lower quality?
A mailed survey was administered to a stratified random sample of NOK of Geisinger Health System patients who had died in the past year. The Quality of Death and Dying, the General Anxiety Disorder seven-item scale, the Patient Health Questionnaire eight-item depression scale, and selected questions from the Toolkit of Instruments to Measure End of Life Care were used.
There were 672 respondents. Significant predictors of Quality of Death and Dying score were number of doctors involved in care (P = 0.0415), location of death (P < 0.0001), frequency of receiving confusing or contradictory information (P < 0.0001), illness progression (P = 0.0343), Patient Health Questionnaire-2 score (P = 0.0148), and General Anxiety Disorder seven-item scale score (P < 0.0070).
Several findings suggest that factors such as NOK depression and anxiety, prolonged illness, dying in the hospital, receipt of conflicting information, and confusion around the doctor in charge are associated with lower quality of the dying and death experience for NOK. Further investigation is warranted to facilitate high-quality measurement and the use of measurement results to improve care.
随着对提高医疗保健价值的日益重视，人们对生命最后几个月的质量结果和高额医疗支出的审查也在增加。
本项目的目的是回答以下问题：1）近亲如何看待其亲人临终和死亡的质量；2）是否存在预测质量较低的患者和近亲特征；3）是否存在与质量较低相关的护理结构方面的问题？
对过去一年去世的盖辛格医疗系统患者的近亲进行分层随机抽样邮寄调查。使用了《死亡与临终质量量表》、《广泛性焦虑障碍七项量表》、《患者健康问卷八项抑郁量表》以及《临终护理测量工具包》中的部分问题。
共有672名受访者。死亡与临终质量得分的显著预测因素包括参与护理的医生数量（P = 0.0415）、死亡地点（P < 0.0001）、收到混乱或矛盾信息的频率（P < 0.0001）、疾病进展情况（P = 0.0343）、患者健康问卷 - 2得分（P = 0.0148）以及广泛性焦虑障碍七项量表得分（P < 0.0070）。
多项研究结果表明，近亲的抑郁和焦虑、病程延长、在医院死亡、收到相互矛盾的信息以及对主治医生的困惑等因素与近亲临终和死亡体验的较低质量相关。有必要进行进一步调查，以促进高质量测量，并利用测量结果改善护理。
