O'Mahony Sean, Kittelson Sheri, Barker Paige C, Delgado Guay Marvin O, Yao Yingwei, Handzo George F, Chochinov Harvey M, Fitchett George, Emanuel Linda L, Wilkie Diana J
Department of Medicine, Rush University, Chicago, Illinois, USA.
Department of Medicine, University of Florida, Gainesville, Florida, USA.
J Palliat Med. 2021 Aug;24(8):1174-1182. doi: 10.1089/jpm.2020.0542. Epub 2021 Mar 23.
End-of-life discussions and documentation of preferences are especially important for older cancer patients who are at high risk of morbidity and mortality. To evaluate influence of demographic factors such as religiosity, education, income, race, and ethnicity on treatment preferences for end-of-life care. A retrospective observational study was performed on baseline data from a multisite randomized clinical trial of Dignity Therapy in 308 older cancer patients who were receiving outpatient palliative care (PC). Interviews addressed end-of-life treatment preferences, religion, religiosity and spirituality, and awareness of prognosis. End-of-life treatment preferences for care were examined, including preferences for general treatment, cardiopulmonary resuscitation (CPR), and mechanical ventilation (MV). Bivariate associations and multiple logistic regression analysis of treatment preferences with demographic and other baseline variables were conducted. Our regression models demonstrated that race was a significant predictor for CPR preference and preferences for MV, although not for general treatment goals. Minority patients were more likely to want CPR and MV than whites. Men were more likely to opt for MV, although not for CPR or overall aggressive treatment, than women. Higher level of education was a significant predictor for preferences for less aggressive care at the end-of-life but not for CPR or MV. Higher level of terminal illness awareness was also a significant predictor for preferences for CPR, but not MV or aggressive care at the end-of-life. Race was significantly associated with all three markers for aggressive care in bivariate analysis and with two out of three markers in multiple regression analysis, with minorities preferring aggressive care and whites preferring less aggressive care. Contrary to our hypothesis, income was not significantly associated with treatment preferences, whereas religion was significantly associated with all markers for aggressive care in bivariate models, but not in multiple regression models. Clinical Trial Registration Number NCT03209440.
对于具有较高发病和死亡风险的老年癌症患者而言，临终讨论和偏好记录尤为重要。旨在评估宗教信仰、教育程度、收入、种族和民族等人口统计学因素对临终护理治疗偏好的影响。对一项尊严疗法多中心随机临床试验的308例接受门诊姑息治疗（PC）的老年癌症患者的基线数据进行了回顾性观察研究。访谈涉及临终治疗偏好、宗教、宗教信仰和精神性以及预后认知。研究了临终护理的治疗偏好，包括对一般治疗、心肺复苏（CPR）和机械通气（MV）的偏好。对治疗偏好与人口统计学和其他基线变量进行了双变量关联分析和多元逻辑回归分析。我们的回归模型表明，种族是CPR偏好和MV偏好的重要预测因素，尽管不是一般治疗目标的预测因素。少数族裔患者比白人更倾向于接受CPR和MV。男性比女性更倾向于选择MV，尽管在CPR或总体积极治疗方面并非如此。较高的教育水平是临终时对积极程度较低护理偏好的重要预测因素，但不是CPR或MV的预测因素。较高的终末期疾病认知水平也是CPR偏好的重要预测因素，但不是MV或临终时积极护理的预测因素。在双变量分析中，种族与所有三个积极护理指标显著相关，在多元回归分析中与三个指标中的两个显著相关，少数族裔倾向于积极护理，而白人倾向于较少积极的护理。与我们的假设相反，收入与治疗偏好没有显著关联，而宗教在双变量模型中与所有积极护理指标显著相关，但在多元回归模型中并非如此。临床试验注册号NCT03209440。
