Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.
Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
Age Ageing. 2021 Jun 28;50(4):1382-1390. doi: 10.1093/ageing/afab049.
Many older adults with severe dementia receive potentially life-extending treatments even when caregivers do not wish to prolong their life inappropriately.
Explore factors that influence caregiver preferences for potentially life-extending treatments for older adults with severe dementia, and reasons for discordance between overall end-of-life care goal and treatment preferences.
Semi-structured in-depth interviews asking caregivers their overall end-of-life care goal for older adults and preferences for intravenous (IV) antibiotics, tube feeding and cardiopulmonary resuscitation (CPR).
A total of 26 caregivers of community-dwelling older adults with severe dementia in Singapore.
Reflexive thematic analysis.
Most caregivers' (77%) overall end-of-life care goal was 'no life extension'. Yet, 80% preferred IV antibiotics for a life-threatening infection, 60% preferred tube feeding and 45% preferred CPR. Caregivers preferred these treatments because they (1) perceived letting go by withholding treatments as unethical, (2) felt they had no choice as they deferred to the health care provider, (3) wanted to alleviate suffering rather than extend life and (4) desired trying minimally invasive treatments that had the potential to be withdrawn. Themes explaining discordance were (1) feared regret about making the 'wrong' decision, (2) considered treatments to address immediate needs even when long-term goal did not match providing that treatment and (3) anticipated disagreement with other family members on overall goal of care.
To reduce discordance between caregivers' overall end-of-life care goal and preferences for life-extending treatments, clinicians can use a shared decision-making approach involving discussions of both their overall end-of-life care goal and treatment preferences.
许多患有严重痴呆症的老年人即使在照顾者不希望不适当地延长其生命的情况下，也会接受可能延长生命的治疗。
探讨影响照顾者对患有严重痴呆症的老年人进行潜在延长生命治疗的偏好的因素，以及整体临终关怀目标与治疗偏好之间不一致的原因。
半结构化深度访谈，询问照顾者对患有严重痴呆症的老年人的整体临终关怀目标以及对静脉（IV）抗生素、管饲和心肺复苏（CPR）的偏好。
新加坡 26 名居住在社区的患有严重痴呆症的老年人的照顾者。
反思性主题分析。
大多数照顾者（77%）的整体临终关怀目标是“不延长生命”。然而，80%的人更喜欢在发生威胁生命的感染时使用 IV 抗生素，60%的人更喜欢管饲，45%的人更喜欢 CPR。照顾者更喜欢这些治疗方法，因为他们 (1) 认为不提供治疗而放弃治疗是不道德的，(2) 感到他们别无选择，只能听从医疗保健提供者的意见，(3) 希望减轻痛苦而不是延长生命，以及 (4) 希望尝试有潜力被撤回的微创治疗。解释不一致的主题是 (1) 担心做出“错误”决定的遗憾，(2) 认为治疗方法可以解决当前的需求，即使长期目标与提供治疗方法不匹配，以及 (3) 预计在整体护理目标上与其他家庭成员存在分歧。
为了减少照顾者的整体临终关怀目标与延长生命治疗偏好之间的不一致，临床医生可以使用一种共同决策方法，涉及他们的整体临终关怀目标和治疗偏好的讨论。
