1 Cecil G. Sheps Center for Health Services Research, University of North Carolina , Chapel Hill, North Carolina.
2 Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina , Chapel Hill, North Carolina.
J Palliat Med. 2018 Oct;21(10):1442-1447. doi: 10.1089/jpm.2018.0103. Epub 2018 Jun 29.
Nursing home (NH) residents with dementia experience high rates of intensive treatment near the end of life. Limited research examines whether treatment is concordant with goals of care (GOC).
We analyzed data from the GOC trial to describe family decision makers' preferred GOC and perceptions of goal-concordant care for NH residents with late-stage dementia We compared subsequent treatment orders when families chose a primary goal of comfort versus other goals.
We performed a secondary analysis of data from baseline and 9-month family decision-maker interviews and chart reviews.
A total of 302 dyads of NH residents and family decision makers in 22 North Carolina NHs were enrolled.
In baseline and follow-up interviews, families reported on their and NH staff's primary GOC, and perceived prognosis and goal-concordant care. Chart reviews provided data on treatment orders, hospital transfers, and hospice, which were compared after selection of a primary goal of comfort versus other goals.
Family chose comfort as the primary goal for 66% of residents at baseline, and for nearly 80% by 9 months or death. At baseline, 49% perceived concordance with NH staff on the primary goal, and 69% at follow-up. In multivariate models, choice of comfort as the primary goal, versus other goals, was associated with half as many hospital transfers (0.11 vs. 0.25/90 person-days, confidence interval [-0.2 to -0.01]), but not with hospice or treatment orders.
Most families chose comfort as the primary GOC. Further research is needed to translate this preference into comfort-focused treatment plans for late-stage dementia. Clinicaltrials.gov : NCT01565642 (3/26/12).
养老院（NH）中患有痴呆症的居民在生命末期接受高强度治疗的比例很高。有限的研究考察了治疗是否与护理目标（GOC）一致。
我们分析了 GOC 试验的数据，以描述家庭决策者对 NH 中晚期痴呆症患者的首选 GOC 和对目标一致的护理的看法。我们比较了当家庭选择主要目标为舒适与其他目标时，随后的治疗顺序。
我们对基线和 9 个月家庭决策者访谈和图表审查的数据进行了二次分析。
共有 22 家北卡罗来纳州 NH 的 302 对 NH 居民和家庭决策者被纳入研究。
在基线和随访访谈中，家庭报告了他们和 NH 工作人员的主要 GOC，以及对预后和目标一致的护理的看法。图表审查提供了关于治疗顺序、医院转院和临终关怀的信息，这些信息在选择主要目标为舒适与其他目标后进行了比较。
家庭在基线时选择舒适作为 66%的居民的主要目标，在 9 个月或死亡时选择了近 80%的目标。在基线时，49%的人认为与 NH 工作人员在主要目标上一致，而在随访时为 69%。在多变量模型中，选择舒适作为主要目标，而不是其他目标，与医院转院的数量减少一半（0.11 比 0.25/90 人天，置信区间[-0.2 到-0.01]），但与临终关怀或治疗顺序无关。
大多数家庭选择舒适作为主要的 GOC。需要进一步研究将这种偏好转化为晚期痴呆症的舒适治疗计划。Clinicaltrials.gov：NCT01565642（3/26/12）。
