Durham VA Health Care System, NC, USA.
Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
J Palliat Care. 2022 Jul;37(3):289-297. doi: 10.1177/08258597211063047. Epub 2021 Dec 13.
Discussing advance care planning (ACP) with care partners may be a steppingstone to the completion of advance directives (ADs) for persons with cognitive impairment (PwCIs). To examine whether PwCI-reported occurrence of and PwCI-care partner agreement about ACP discussions are associated with completion of ADs. We conducted a secondary, cross-sectional analysis of data from 1672 PwCI-care partner dyads in the BLINDED study. PwCIs were Medicare beneficiaries in the US, aged 65 years, and diagnosed with mild cognitive impairment or dementia. Care partners were identified by PwCIs as being most involved in their health care. PwCIs' completion of ADs was determined by 1 or more affirmative responses to dichotomous indicators for formalizing a living will, medical directive, or durable power of attorney for health care. Discussion occurrence was based on PwCI reports and agreement between PwCI and care partner reports of prior conversations about PwCIs' ACP preferences between PwCIs and care partners. In logistic regression models adjusted for PwCI and care partner characteristics, PwCIs who had (vs. had not) discussed ACP were 10% more likely to complete ADs. PwCIs from dyads agreeing (vs. disagreeing) a discussion occurred were 7% more likely to complete ADs. PwCIs from care dyads in agreement (vs. disagreement) about non-discussion were 11% less likely to formalize ADs. Discussing ACP with care partners plays a direct, positive role in completing ADs among PwCIs. Health care providers who approach ACP as a dyadic, communicative decision-making process from the outset may facilitate PwCIs' uptake of ADs.
与护理伙伴讨论预先护理计划（ACP）可能是完成认知障碍（PwCI）患者预先指示（AD）的一个步骤。本研究旨在探讨 PwCI 报告的 ACP 讨论发生情况和 PwCI 护理伙伴对 ACP 讨论的共识是否与 AD 的完成相关。我们对 BLINDED 研究中 1672 对 PwCI-护理伙伴进行了二次横断面数据分析。PwCI 是美国的医疗保险受益人，年龄 65 岁，被诊断为轻度认知障碍或痴呆。护理伙伴由 PwCI 确定为最参与其医疗保健的人。通过对 1 个或多个正式制定生前遗嘱、医疗指示或持久医疗授权书的二分指标的肯定回答来确定 PwCI 完成 AD 的情况。讨论发生是基于 PwCI 的报告以及 PwCI 和护理伙伴报告的关于 PwCI 和护理伙伴之间的 ACP 偏好的先前对话之间的共识。在调整了 PwCI 和护理伙伴特征的逻辑回归模型中，与未讨论 ACP 的 PwCI 相比，讨论过 ACP 的 PwCI 完成 AD 的可能性增加 10%。来自同意（vs.不同意）讨论发生的对偶的 PwCI 完成 AD 的可能性增加 7%。在关于非讨论的一致性（vs.不一致性）方面，来自护理对偶的 PwCI 完成 AD 的可能性降低 11%。与护理伙伴讨论 ACP 在 PwCI 中完成 AD 方面起着直接的、积极的作用。从一开始就将 ACP 作为一个双重视角、沟通性决策过程来处理的医疗保健提供者可能会促进 PwCI 接受 AD。
