认知正常和认知障碍成年人的治疗偏好。
Treatment preferences among adults with normal cognition and cognitive impairment.
机构信息
Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
University of Michigan Institute for Social Research, Ann Arbor, Michigan, USA.
出版信息
J Am Geriatr Soc. 2022 Dec;70(12):3390-3401. doi: 10.1111/jgs.18032. Epub 2022 Sep 12.
BACKGROUND
Although patient participation in treatment decisions is important for preference-concordant care delivery, it is largely unknown how cognitive impairment influences treatment preferences. We investigated whether treatment preferences for the care of serious illness differ between adults with and without cognitive impairment in hypothetical clinical scenarios.
METHODS
Data from the 2018 Health and Retirement Study were used. The sample included 1291 self-respondents (201 respondents with cognitive impairment, and 1090 with normal cognition). We examined treatment preferences for life-extending, limited, and comfort care options in two hypothetical clinical scenarios where the respondent imagines a patient with (1) good physical health with severe cognitive impairment consistent with dementia; and (2) with physical impairment due to a heart attack, but normal cognition. Respondents specified whether they were unsure, or if they would want or not want each treatment option. Linear probability models were used to compare treatment preferences by cognitive status.
RESULTS
Respondents with cognitive impairment were more likely to report that they were unsure about treatment options across both clinical scenarios compared to those with normal cognition. For the limited treatment option, cognitive impairment was associated with a lower rate of expressing a treatment preference by 7.3 (p = 0.070) and 8.5 (p = 0.035) percentage points for dementia and heart attack scenarios, respectively. Among those who articulated preferences, cognitive impairment was associated with a higher rate of preference for life-extending treatment in both dementia (30.1% vs. 20.0%, p = 0.044) and heart attack scenarios (30.0% vs. 20.2%, p = 0.033).
CONCLUSIONS
Compared to those with normal cognition, cognitive impairment was associated with greater uncertainty about treatment preferences and higher rates of aggressive care preferences among those who specified preferences. Further research should assess whether preferences for aggressive care become more common as cognition declines in order to improve preference-concordant care delivery for patients with cognitive impairment.
背景
尽管患者参与治疗决策对于提供符合偏好的护理至关重要，但认知障碍如何影响治疗偏好尚不清楚。我们研究了在假设的临床情况下，严重疾病的治疗偏好是否在认知障碍患者和认知正常患者之间存在差异。
方法
使用 2018 年健康与退休研究的数据。样本包括 1291 名自我报告者（201 名认知障碍患者和 1090 名认知正常患者）。我们在两个假设的临床情景中检查了对延长生命、有限和舒适护理选项的治疗偏好，在这些情景中，受访者想象一位患者患有（1）身体健康但认知严重受损符合痴呆症；和（2）因心脏病发作导致身体损伤但认知正常。受访者指定他们是否不确定，或者是否想要或不想要每种治疗选择。线性概率模型用于比较认知状况下的治疗偏好。
结果
与认知正常患者相比，认知障碍患者在两个临床情景中对治疗选择不确定的可能性更高。对于有限的治疗选择，认知障碍与表达治疗偏好的比率降低了 7.3（p=0.070）和 8.5（p=0.035）个百分点，分别用于痴呆症和心脏病发作情景。在表达偏好的人中，认知障碍与痴呆症（30.1%比 20.0%，p=0.044）和心脏病发作情景（30.0%比 20.2%，p=0.033）中更倾向于延长生命的治疗。
结论
与认知正常患者相比，认知障碍与对治疗偏好的更大不确定性以及在那些指定偏好的人中更倾向于积极治疗的更高比率相关。进一步的研究应该评估随着认知能力下降，积极治疗的偏好是否变得更为普遍，以便为认知障碍患者提供更符合偏好的护理。
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