Chuang I-Fei, Shyu Yea-Ing Lotus, Weng Li-Chueh, Huang Hsiu-Li
Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan.
School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
Patient Prefer Adherence. 2020 Dec 3;14:2377-2387. doi: 10.2147/PPA.S283923. eCollection 2020.
This study explored the consistency between preferences for end-of-life care for elderly hospitalized patients and their primary caregivers and predictors of consistency.
This cross-sectional correlational study recruited 100 dyads of elderly hospitalized patients and their primary caregivers from a medical center in Central Taiwan. A structural questionnaire about preferences for seven end-of-life medical treatment options involved cardiopulmonary resuscitation, intravenous therapy, nasogastric tube feeding, intensive care unit, blood transfusion, tracheotomy, and hemodialysis.
The consistency was 42.28% for preferences of end-of-life medical care between patients and caregivers. The Kappa values for seven life-sustaining medical treatments ranged from 0.001 to 0.155. Logistic regression showed that the predictors of consistency for preferences of treatment were: a patient with a signed living will (odds ratio [OR] = 6.20, p<0.01) and a male family caregiver (OR= 0.23, p<0.01) for cardiopulmonary resuscitation; a patient who visited relatives in the intensive care unit (OR= 2.94, p< 0.05) and a spouse caregiver (OR= 3.07, p< 0.05) for nasogastric tube feeding; a spouse caregiver (OR=3.12, p<0.05) and a caregiver who visited the intensive care unit (OR= 5.50, p<0.01) for tracheotomy; and a spouse caregiver (OR= 2.76, p<0.05) and a caregiver who visited the intensive care unit (OR= 4.42, p<0.05) for hemodialysis.
End-of-life medical treatment preferences were inconsistent between patients and family caregivers, which might be influenced by Asian culture, the nature of the relationship and individual experiences. Implementation of advance care planning that respects the patient's autonomy and preferences about end-of-life care is recommended.
本研究探讨老年住院患者及其主要照顾者对临终关怀的偏好之间的一致性以及一致性的预测因素。
这项横断面相关性研究从台湾中部的一家医疗中心招募了100对老年住院患者及其主要照顾者。一份关于七种临终医疗治疗选择偏好的结构化问卷，涉及心肺复苏、静脉治疗、鼻饲管喂食、重症监护病房、输血、气管切开术和血液透析。
患者和照顾者在临终医疗护理偏好方面的一致性为42.28%。七种维持生命医疗治疗的Kappa值范围为0.001至0.155。逻辑回归显示，治疗偏好一致性的预测因素为：签署生前预嘱的患者（比值比[OR]=6.20，p<0.01）以及男性家庭照顾者（OR=0.23，p<0.01）对心肺复苏的偏好；在重症监护病房探望过亲属的患者（OR=2.94，p<0.05）以及配偶照顾者（OR=3.07，p<0.05）对鼻饲管喂食的偏好；配偶照顾者（OR=3.12，p<0.05）以及在重症监护病房探望过的照顾者（OR=5.50，p<0.01）对气管切开术的偏好；以及配偶照顾者（OR=2.76，p<0.05）和在重症监护病房探望过的照顾者（OR=4.42，p<0.05）对血液透析的偏好。
患者和家庭照顾者在临终医疗治疗偏好上不一致，这可能受到亚洲文化、关系性质和个人经历的影响。建议实施尊重患者自主权和临终关怀偏好的预先护理计划。
