Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, McGill University, Montreal, Canada.
Geri-PARTy Research Group, Department of Psychiatry, Jewish General Hospital, McGill University, Montreal, Canada.
Am J Geriatr Psychiatry. 2018 Jan;26(1):89-97. doi: 10.1016/j.jagp.2017.09.018. Epub 2017 Sep 25.
Physicians rarely engage severe and persistent mental illness (SPMI) patients in end-of-life care discussion despite an increased risk of debilitating medical illnesses and mortality. Access to quality palliative care and medical assistance in dying (MAID) has become a priority in Canada and many jurisdictions. In this study, we compared SPMI and chronic medically ill (CMI) patients' end-of-life care preferences and comfort level with end-of-life care discussion, and identified potential predictors of interest in MAID.
Comparative cross-sectional study.
Hospital-based.
We recruited 106 SPMI and 95 CMI patients at the Jewish General Hospital, Canada. Patients aged ≥40 years, without severe cognitive impairment, able to communicate in English or French and provide written informed consent were included.
Attitudes towards pain management, palliative sedation, MAID, and artificial life support were collected with the Health Care Preferences Questionnaire. Adjusted odd ratios (aOR) were calculated for each end-of-life care intervention. Comfort with discussion was rated on a Likert scale. A stepwise regression analysis was performed to identify predictors of interest in MAID.
SPMI was not correlated to any end-of-life care intervention, except for MAID where SPMI patients were less likely to support its use (aOR: 0.48, 95% CI: 0.25-0.94, p = 0.03). Religiosity was also correlated with interest in MAID (aOR: 0.14, 95% CI: 0.06-0.31, p < 0.001). Patients in both groups were comfortable talking about end-of-life care.
SPMI patients are able to voice their end-of-life care preferences, and contrary to some fears, do not want MAID more than CMI patients.
尽管患有严重和持续性精神疾病（SPMI）的患者面临更高的衰弱性疾病和死亡率风险，但医生很少与他们讨论临终关怀。在加拿大和许多司法管辖区，获得高质量的姑息治疗和医疗辅助自杀（MAID）已成为优先事项。在这项研究中，我们比较了 SPMI 和患有慢性医学疾病（CMI）的患者对临终关怀的偏好以及对临终关怀讨论的舒适度，并确定了对 MAID 感兴趣的潜在预测因素。
比较性横断面研究。
基于医院。
我们在加拿大犹太总医院招募了 106 名 SPMI 和 95 名 CMI 患者。纳入标准为年龄≥40 岁、无严重认知障碍、能够用英语或法语交流并提供书面知情同意的患者。
使用医疗保健偏好问卷收集对疼痛管理、姑息性镇静、MAID 和人工生命支持的态度。为每种临终关怀干预措施计算了调整后的优势比（aOR）。讨论舒适度的评分采用 Likert 量表。进行逐步回归分析以确定对 MAID 感兴趣的预测因素。
SPMI 与任何临终关怀干预措施均无相关性，除了 MAID，SPMI 患者不太支持使用 MAID（aOR：0.48，95%CI：0.25-0.94，p=0.03）。宗教信仰也与对 MAID 的兴趣相关（aOR：0.14，95%CI：0.06-0.31，p<0.001）。两组患者都愿意谈论临终关怀。
SPMI 患者能够表达自己的临终关怀偏好，与一些担忧相反，他们并不比 CMI 患者更希望接受 MAID。
