Dassel Kara B, Utz Rebecca, Supiano Katherine, McGee Nancy, Latimer Seth
1 College of Nursing, University of Utah, Salt Lake City, UT, USA.
2 College of Social and Behavioral Science, University of Utah, Salt Lake City, UT, USA.
Am J Hosp Palliat Care. 2018 Jan;35(1):52-59. doi: 10.1177/1049909116680990. Epub 2016 Dec 17.
Differences in end-of-life (EOL) care preferences (eg, location of death, use of life-sustaining treatments, openness to hastening death, etc) based on hypothetical death scenarios and associated physical and/or cognitive losses have yet to be investigated within the palliative care literature.
The purpose of this study was to explore the multidimensional EOL care preferences in relation to 3 different hypothetical death scenarios: pancreatic cancer (acute death), Alzheimer disease (gradual death), and congestive heart failure (intermittent death).
General linear mixed-effects regression models estimated whether multidimensional EOL preferences differed under each of the hypothetical death scenarios; all models controlled for personal experience and familiarity with the disease, presence of an advance directive, religiosity, health-related quality of life, and relevant demographic characteristics.
SETTING/PARTICIPANTS: A national sample of healthy adults aged 50 years and older (N = 517) completed electronic surveys detailing their multidimensional preferences for EOL care for each hypothetical death scenario.
The average age of the participants was 60.1 years (standard deviation = 7.6), 74.7% were female, and 66.1% had a college or postgraduate degree. Results revealed significant differences in multidimensional care preferences between hypothetical death scenarios related to preferences for location of death (ie, home vs medical facility) and preferences for life-prolonging treatment options. Significant covariates of participants' multidimensional EOL care preferences included age, sex, health-related quality of life, and religiosity.
Our hypothesis that multidimensional EOL care preferences would differ based on hypothetical death scenarios was partially supported and suggests the need for disease-specific EOL care discussions.
在姑息治疗文献中，尚未对基于假设死亡情景以及相关身体和/或认知丧失的临终（EOL）护理偏好差异（例如，死亡地点、维持生命治疗的使用、对加速死亡的接受程度等）进行研究。
本研究的目的是探讨与三种不同假设死亡情景相关的多维临终护理偏好：胰腺癌（急性死亡）、阿尔茨海默病（渐进性死亡）和充血性心力衰竭（间歇性死亡）。
通用线性混合效应回归模型估计了在每种假设死亡情景下多维临终偏好是否存在差异；所有模型都控制了个人对疾病的经历和熟悉程度、预先指示的存在、宗教信仰、与健康相关的生活质量以及相关人口统计学特征。
设置/参与者：一个由50岁及以上健康成年人组成的全国性样本（N = 517）完成了电子调查，详细说明了他们对每种假设死亡情景下临终护理的多维偏好。
参与者的平均年龄为60.1岁（标准差 = 7.6），74.7%为女性，66.1%拥有大学或研究生学位。结果显示，在与死亡地点偏好（即家中与医疗机构）和延长生命治疗选择偏好相关的假设死亡情景之间，多维护理偏好存在显著差异。参与者多维临终护理偏好的显著协变量包括年龄、性别、与健康相关的生活质量和宗教信仰。
我们关于多维临终护理偏好会因假设死亡情景而异的假设得到了部分支持，并表明需要针对特定疾病进行临终护理讨论。
