Department of Neurology (L.E.S., C.C.L.), Health Services Research Program, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Department of Neurology (L.E.S., C.C.L.), Health Services Research Program, University of Michigan Medical School, Ann Arbor, Michigan, USA.
J Pain Symptom Manage. 2022 Oct;64(4):e189-e194. doi: 10.1016/j.jpainsymman.2022.06.012. Epub 2022 Jun 25.
Advance Care Planning is a process of understanding and sharing preferences regarding future medical care.
To explore individual and national stability of end-of-life treatment preferences among a sample of older adults.
National Health and Aging Trends Study is a nationally representative sample of older adults. In 2012, a random sample, and in 2018, the entire sample were queried on end-of-life treatment preferences defined as acceptance or rejection of life prolonging treatment (LPT) if they had a serious illness and were at the end of their life and in severe pain or had severe disability. Using a cohort design, we explored individual trends in preferences for LPT among those with responses in both waves (pain scenario: N = 606, disability scenario: N = 628) and, using a serial cross-sectional design, national trends in LPT among the entire sample (1702 older adults in wave 2 and 4342 in wave 8).
In the cohort study, individual preferences were stable over time (overall percent agreement = 86% for disability and 76% for pain scenarios), particularly for older adults who would reject LPT in wave 2 (overall agreement 92% for disability and 86% for pain). In the serial cross-sectional study, national trends in preferences for receipt of LPT were stable over time in the pain (27.4% vs. 27.0%, P = 0.80) and disability (15.8% vs. 15.7%, P = 0.99) scenarios.
We found that national trends in preferences for end-of-life treatment did not substantially change over time and may be stable within individual older adults.
预先医疗照护计划是一个了解和分享未来医疗照护偏好的过程。
探索老年人群样本中临终治疗偏好的个体和国家稳定性。
国家健康老龄化趋势研究是一个具有代表性的老年人群样本。在 2012 年，对一个随机样本进行了调查，在 2018 年，对整个样本进行了调查，询问了临终治疗偏好，即如果他们患有严重疾病，生命即将结束，处于严重疼痛或严重残疾状态，是否接受或拒绝延长生命的治疗（LPT）。使用队列设计，我们在两个波次（疼痛场景：N=606，残疾场景：N=628）中有应答的人群中，探讨了对 LPT 的个体偏好趋势，并且使用系列横断面设计，在整个样本中（波次 2 中为 1702 名老年人，波次 8 中为 4342 名老年人）探讨了 LPT 的国家趋势。
在队列研究中，个体偏好随着时间的推移保持稳定（残疾场景的总体一致性为 86%，疼痛场景的总体一致性为 76%），特别是在波次 2 中拒绝 LPT 的老年人（残疾场景的总体一致性为 92%，疼痛场景的总体一致性为 86%）。在系列横断面研究中，疼痛（27.4%比 27.0%，P=0.80）和残疾（15.8%比 15.7%，P=0.99）场景中，LPT 接受偏好的国家趋势随着时间的推移保持稳定。
我们发现，临终治疗偏好的国家趋势并没有随着时间的推移发生实质性变化，并且在个体老年人中可能是稳定的。
