接受临终关怀的障碍：一项基于随机案例的实验。

Barriers of Acceptance to Hospice Care: a Randomized Vignette-Based Experiment.

机构信息

Emory University, Atlanta, GA, USA.

Northwestern University, Chicago, USA.

出版信息

J Gen Intern Med. 2023 Feb;38(2):277-284. doi: 10.1007/s11606-022-07468-7. Epub 2022 Mar 22.

DOI:10.1007/s11606-022-07468-7

PMID:35319086

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9905383/

Abstract

BACKGROUND

The per diem financial structure of hospice care may lead agencies to consider patient-level factors when weighing admissions.

OBJECTIVE

To investigate if treatment cost, disease complexity, and diagnosis are associated with hospice willingness to accept patients.

DESIGN

In this 2019 online survey study, individuals involved in hospice admissions decisions were randomized to view one of six hypothetical patient vignettes: "high-cost, high-complexity," "low-cost, high-complexity," and "low-cost, low-complexity" within two diseases: heart failure and cystic fibrosis. Vignettes included demographics, prognoses, goals, and medications with costs. Respondents indicated their perceived likelihood of acceptance to their hospice; if likelihood was <100%, respondents were asked the barriers to acceptance. We used bivariate tests to examine associations between demographic, clinical, and organizational factors and likelihood of acceptance.

PARTICIPANTS

Individuals involved in hospice admissions decisions MAIN MEASURES: Likelihood of acceptance to hospice care KEY RESULTS: N=495 (76% female, 53% age 45-64). Likelihoods of acceptance in cystic fibrosis were 79.8% (high-cost, high-complexity), 92.4% (low-cost, high-complexity), and 91.5% (low-cost, low-complexity), and in heart failure were 65.9% (high-cost, high-complexity), 87.3% (low-cost, high-complexity), and 96.6% (low-cost, low-complexity). For both heart failure and cystic fibrosis, respondents were less likely to accept the high-cost, high-complexity patient than the low-cost, high-complexity patient (65.9% vs. 87.3%, 79.8% vs. 92.4%, both p<0.001). For heart failure, respondents were less likely to accept the low-cost, high-complexity patient than the low-cost, low-complexity patient (87.3% vs. 96.6%, p=0.004). Treatment cost was the most common barrier for 5 of 6 vignettes.

CONCLUSIONS

This study suggests that patients receiving expensive and/or complex treatments for palliation may have difficulty accessing hospice.

摘要

背景

临终关怀的日费财务结构可能导致机构在考虑入院时考虑患者层面的因素。

目的

调查治疗费用、疾病复杂性和诊断是否与临终关怀机构愿意接受患者相关。

设计

在这项 2019 年的在线调查研究中，参与临终关怀入院决策的人员被随机分配查看六个假设患者病例中的一个：“高成本、高复杂性”、“低成本、高复杂性”和“低成本、低复杂性”，疾病为心力衰竭和囊性纤维化。病例包括人口统计学、预后、目标和药物费用。受访者表示他们对自己接受临终关怀的可能性；如果可能性<100%，则要求受访者回答接受的障碍。我们使用双变量检验来检查人口统计学、临床和组织因素与接受可能性之间的关联。

参与者

参与临终关怀入院决策的人员

主要措施

对临终关怀的接受意愿

主要结果

n=495（76%为女性，53%年龄在 45-64 岁）。囊性纤维化的接受意愿分别为 79.8%（高成本、高复杂性）、92.4%（低成本、高复杂性）和 91.5%（低成本、低复杂性），心力衰竭的接受意愿分别为 65.9%（高成本、高复杂性）、87.3%（低成本、高复杂性）和 96.6%（低成本、低复杂性）。对于心力衰竭和囊性纤维化，受访者接受高成本、高复杂性患者的可能性均低于低成本、高复杂性患者（65.9%对 87.3%，79.8%对 92.4%，均 p<0.001）。对于心力衰竭，受访者接受低成本、高复杂性患者的可能性低于低成本、低复杂性患者（87.3%对 96.6%，p=0.004）。在 6 个病例中，有 5 个的治疗费用是最常见的障碍。