Bern-Klug Mercedes, Singh Jaswinder, Liu Jinyu, Shinkunas Laura
a School of Social Work , University of Iowa , Iowa City , Iowa , USA.
b Mercy Medical Center , Nurse Intern , Des Moines , Iowa , USA.
J Soc Work End Life Palliat Care. 2019 Jan-Mar;15(1):34-54. doi: 10.1080/15524256.2019.1580242. Epub 2019 Mar 20.
Family members are often involved in medical decision-making on behalf of a nursing home resident. Prospect theory provides a framework for understanding how people weigh decisions. In the current study, prospect theory concepts are used to build understanding about how family members weigh medical decisions for an NH resident diagnosed with cancer. This is a secondary analysis of qualitative interview data from 24 family members of nursing home residents. Prospect theory concepts of gain, loss, risk, and reference point were used deductively in qualitative content analysis. Themes were developed by comparing content related to these four concepts, across the transcripts from the 24 participants. Three themes comprise the main findings, including "Don't prolong this," "A good ending is a gain," and "Experience can facilitate seeing the big picture." Prospect theory concepts applied to decisions faced by family members were useful in building an understanding of what participants considered as gains, losses, risks, and reference points. Many participants framed the medical decisions within the larger context of the resident's life and concluded that jeopardizing the chance for a peaceful dying process was too high a risk. Medical interventions were selected or avoided because of the impact on a comfortable dying process; considered a gain. Advance care planning discussions and goals of care discussions can benefit by directly addressing what residents/patients, families, and health practitioners consider outcomes worth pursuing and avoiding.
家庭成员通常会代表疗养院居民参与医疗决策。前景理论提供了一个理解人们如何权衡决策的框架。在当前的研究中，前景理论的概念被用于增进对家庭成员如何权衡为被诊断患有癌症的疗养院居民做出医疗决策的理解。这是对来自24位疗养院居民家庭成员的定性访谈数据的二次分析。前景理论中的收益、损失、风险和参考点概念在定性内容分析中被演绎性地运用。通过比较24位参与者的访谈记录中与这四个概念相关的内容来提炼主题。三个主题构成了主要研究结果，包括“不要拖延”“一个好的结局就是一种收获 ”以及“经验有助于纵观全局”。将前景理论概念应用于家庭成员面临的决策，有助于理解参与者所认为的收益、损失、风险和参考点。许多参与者将医疗决策置于居民生活的更大背景中，并得出结论，危及平静死亡过程的风险过高。由于对舒适的死亡过程有影响，医疗干预措施被选择或避免；这被视为一种收获。预先护理计划讨论和护理目标讨论可以通过直接探讨居民/患者、家庭和医疗从业者认为值得追求和避免的结果而受益。
