Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada.
School of Public and Population Health at the University of British Columbia, Vancouver, BC, Canada.
BMC Med Inform Decis Mak. 2017 Dec 6;17(1):164. doi: 10.1186/s12911-017-0570-x.
Decisions about care options and the use of life-sustaining treatments should be informed by a person's values and treatment preferences. The objective of this study was to examine the consistency of ratings of the importance of the values statements and the association between values statement ratings and the patient's expressed treatment preference.
We conducted a multi-site survey in 20 family practices. Patients aged 50 and older self-completed a questionnaire assessing the importance of eight values (rated 1 to 10), and indicated their preference for use of life-sustaining treatment (5 options). We compared correlations among values to a priori hypotheses based on whether the value related to prolonging or shortening life, and examined expected relationships between importance of values and the preference option for life-sustaining treatment.
Eight hundred ten patients participated (92% response rate). Of 24 a priori predicted correlations among values statements, 14 were statistically significant but nearly all were negligible in their magnitude and some were in the opposite direction than expected. For example, the correlation between importance of being comfortable and suffering as little as possible and the importance of living as long as possible should have been inversely correlated but was positively correlated (r = 0.08, p = 0.03). Correlations between importance of values items and preference were negligible, ranging from 0.03 to 0.13.
Patients may not recognize that trade-offs in what is most important may be needed when considering the use of treatments. In the context of preparation for decision-making during serious illness, decision aids that highlight these trade-offs and connect values to preferences more directly may be more helpful than those that do not.
医疗照护选项和生命维持治疗的使用决策，应基于个人的价值观和治疗偏好。本研究旨在检验价值观陈述重要性评分的一致性，以及价值观陈述评分与患者表达的治疗偏好之间的关联。
我们在 20 个家庭医疗诊所进行了一项多地点调查。年龄在 50 岁及以上的患者自行完成了一份评估 8 种价值观（评分 1-10 分）重要性的问卷，并表明其对使用生命维持治疗的偏好（5 种选择）。我们比较了价值观之间的相关性与基于该价值观是否与延长或缩短寿命相关的先验假设，同时检验了价值观重要性与生命维持治疗偏好选项之间的预期关系。
810 名患者参与（92%的响应率）。在 24 个先验预测的价值观陈述相关性中，有 14 个具有统计学意义，但几乎所有相关性的幅度都很小，有些甚至与预期方向相反。例如，舒适和尽量减少痛苦与尽可能延长生命之间的重要性之间的相关性本应呈反比，但实际上呈正相关（r=0.08，p=0.03）。价值观项目与偏好之间的相关性很微弱，范围在 0.03 到 0.13 之间。
患者在考虑治疗时，可能没有意识到在最重要的事情之间可能需要做出权衡。在严重疾病决策制定准备的背景下，突出这些权衡并更直接地将价值观与偏好联系起来的决策辅助工具可能比不这样做的工具更有帮助。
