Houben Carmen H M, Spruit Martijn A, Schols Jos M G A, Wouters Emiel F M, Janssen Daisy J A
Department of Research and Education, CIRO, Horn, The Netherlands.
Department of Research and Education, CIRO, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.
Chest. 2017 May;151(5):1081-1087. doi: 10.1016/j.chest.2016.12.003. Epub 2016 Dec 19.
For optimal end-of-life decision-making, it is important to understand the stability of patients' treatment preferences. The aim of this paper is to examine the stability of willingness to accept life-sustaining treatments during 1-year follow-up in Dutch patients with advanced chronic organ failure. In addition, we want to explore the association between willingness to accept high-burden treatment and preferences for CPR and mechanical ventilation (MV).
In this multicenter longitudinal study, 265 clinically stable outpatients with advanced COPD (Global Initiative for Chronic Obstructive Lung Disease stage III/IV [n = 105]), chronic heart failure (New York Heart Association class III/IV [n = 80]), or chronic renal failure (requiring dialysis [n = 80) were visited at baseline and at 4, 8, and 12 months to assess the stability of life-sustaining treatment preferences using the Willingness to Accept Life-sustaining Treatment instrument.
Two hundred six patients completed 1-year follow-up (mean age, 67.2 years [SD, 13.1 years]; 64.1% men). Overall, proportions of patients who were willing to accept life-sustaining treatment during 1 year did not change over time. However, individual trajectories showed that about two-thirds of patients changed their preferences at least once during a year. Moreover, there was no association found between the stability of willingness to undergo high-burden therapy and the stability of preferences for CPR and MV.
The current findings show the complexity of preferences for end-of-life care and indicate once again that advance care planning is a continuous process between patients and physicians, in which preferences for specific situations are discussed and that needs to be regularly reevaluated to deliver high-quality end-of-life care.
Netherlands National Trial Register (NTR 1552).
为了做出最佳的临终决策，了解患者治疗偏好的稳定性很重要。本文的目的是研究荷兰晚期慢性器官衰竭患者在1年随访期间接受维持生命治疗意愿的稳定性。此外，我们还想探讨接受高负担治疗的意愿与心肺复苏（CPR）及机械通气（MV）偏好之间的关联。
在这项多中心纵向研究中，对265名临床状况稳定的晚期慢性阻塞性肺疾病（慢性阻塞性肺疾病全球倡议组织III/IV期[n = 105]）、慢性心力衰竭（纽约心脏协会III/IV级[n = 80]）或慢性肾衰竭（需要透析[n = 80]）的门诊患者进行了基线以及第4、8和12个月的随访，使用接受维持生命治疗意愿量表评估维持生命治疗偏好的稳定性。
206名患者完成了1年的随访（平均年龄67.2岁[标准差13.1岁]；男性占64.1%）。总体而言，1年内愿意接受维持生命治疗的患者比例未随时间变化。然而，个体轨迹显示，约三分之二的患者在1年内至少改变了一次偏好。此外，接受高负担治疗意愿的稳定性与CPR和MV偏好的稳定性之间未发现关联。
目前的研究结果显示了临终护理偏好的复杂性，并再次表明预先护理计划是患者与医生之间的一个持续过程，其中要讨论针对特定情况的偏好，并且需要定期重新评估以提供高质量的临终护理。
荷兰国家试验注册库（NTR 1552）。
