Imperial College London (M.O., E.M.), Department of Surgery and Cancer, London, UK.
Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School (H.W.), Boston, Massachusetts, USA; Department of Medicine, Cardiology Section, VA Boston Healthcare System (H.W.), Boston, Massachusetts, USA.
J Pain Symptom Manage. 2021 Dec;62(6):1198-1206. doi: 10.1016/j.jpainsymman.2021.05.018. Epub 2021 May 29.
Americans express a strong preference for participating in decisions regarding their medical care, yet they are often unable to participate in decision-making regarding their end-of-life care.
To examine determinants of end-of-life planning; including, the effect of an individual's ageing and dying process, health status and socio-economic and racial/ethnic background.
US observational cohort study, using data from the Health and Retirement Study (1992 - 2014) including 37,494 individuals. Random-effects logistic regression analysis was used to examine the relationship between the presence of a living will and a range of individual time-varying characteristics, including time to death, and several time-invariant characteristics.
End-of-life planning depends on several patient characteristics and circumstances, with socio-economic and racial/ethnic background having the largest effects. The probability of having a living will rises sharply late in life, as we would expect, and is further modified by the patient's proximity to death. The dying process, exerts a stronger influence on end-of-life planning than does the aging.
Understanding differences that increase end-of-life planning is important to incentivize patients' participation. Advance planning should be encouraged and accessible to people of all ages as it is inevitable for the provision of patient-centered and cost-effective care.
美国人强烈倾向于参与他们的医疗保健决策,但他们往往无法参与他们的临终关怀决策。
研究决定临终关怀计划的因素;包括个人的衰老和死亡过程、健康状况以及社会经济和种族/民族背景的影响。
使用来自健康与退休研究(1992-2014 年)的数据进行美国观察性队列研究,包括 37494 人。随机效应逻辑回归分析用于检查存在生前遗嘱与一系列个体时变特征之间的关系,包括死亡时间和几个时不变特征。
临终关怀计划取决于几个患者特征和情况,社会经济和种族/民族背景的影响最大。如我们所预期的那样,生前遗嘱的可能性在生命的后期急剧上升,并且进一步受到患者接近死亡的影响。死亡过程对临终关怀计划的影响比衰老更大。
了解增加临终关怀计划的差异对于激励患者的参与非常重要。应鼓励并为所有年龄段的人提供预先计划,因为这对于提供以患者为中心和具有成本效益的护理是不可避免的。