5116University of Southern California, Los Angeles, CA, USA.
Am J Hosp Palliat Care. 2023 Feb;40(2):147-152. doi: 10.1177/10499091221097676. Epub 2022 May 5.
Having an advance directive (AD) is associated with better care at end of life and better quality of death. However, AD completion rates among End-Stage Renal Disease patients are lower than among cancer patients. ESRD patients commonly experience cognitive impairment, reducing their ability to make their own care choices as their disease progresses. Thus, having an AD earlier in the disease trajectory is important. Little is known about differences in AD completion timing among ESRD and cancer patients. Therefore, the purpose of this study was to (1) investigate difference in AD completion and timing between ESRD and cancer patients; and, (2) identify factors associated with the early and late AD completion. A retrospective cohort study was conducted. Data was drawn from the Health and Retirement Study, a United States representative longitudinal survey of older adults, using exit interviews conducted from 2006 to 2016 among 1886 proxy reporters of deceased participants with ESRD or cancer. ESRD patients had lower rates of AD completion compared to those with cancer. Higher education and being older were negatively associated with late AD completion in the last 3 months of life. Additionally, decedents with a diagnosis of ESRD, older age, and with higher education had higher odds of completing ADs one year or more before death. While ESRD patient were less likely to have ADs, those that had ADS were more likely than cancer patients to develop ADs earlier in the disease trajectory. Further studies are needed to determine effective strategies to increase the AD completion rate among patients with ESRD.
拥有预立医疗指示（AD）与临终关怀质量的提高和死亡质量的改善有关。然而，终末期肾病（ESRD）患者的 AD 完成率低于癌症患者。ESRD 患者通常会出现认知障碍，随着疾病的进展，他们做出自己护理选择的能力会下降。因此，在疾病进程的早期制定 AD 非常重要。关于 ESRD 和癌症患者 AD 完成时间的差异知之甚少。因此，本研究的目的是：（1）调查 ESRD 和癌症患者 AD 完成情况和时间的差异；（2）确定与 AD 早期和晚期完成相关的因素。本研究采用回顾性队列研究方法。数据来自美国健康与退休研究（Health and Retirement Study），这是一项针对老年人群的具有代表性的纵向调查，使用 2006 年至 2016 年期间对患有 ESRD 或癌症的已故参与者的 1886 名代理报告者进行的离职访谈。与癌症患者相比，ESRD 患者的 AD 完成率较低。受教育程度较高和年龄较大与生命最后 3 个月内 AD 完成较晚呈负相关。此外，患有 ESRD 诊断、年龄较大和受教育程度较高的死者更有可能在死亡前一年或更早完成 AD。虽然 ESRD 患者制定 AD 的可能性较低，但与癌症患者相比，他们制定 AD 的可能性更高，而且在疾病进程的早期就制定 AD。需要进一步研究以确定增加 ESRD 患者 AD 完成率的有效策略。
