Lewis Ebony T, Hammill Kathrine, Culbert Rebekah, van der Merwe Madeleen, Sahay Ashlyn, Turner Robin, Cardona Magnolia
School of Population Health, University of New South Wales, Sydney 2052, Australia.
School of Psychology, The University of New South Wales, Sydney 2052, Australia.
Healthcare (Basel). 2023 Feb 3;11(3):444. doi: 10.3390/healthcare11030444.
Shared decision making near end of life is a balancing act of communicating prognosis to patients and their surrogates/families and engaging them in considering value-concordant management choices. This cross-sectional survey aimed to determine the format in which older patients with chronic illnesses would prefer to receive prognostic information on their treatment options and disease progression, and their desired level of engagement in decision making. With a 60% participation rate, 139 inpatients in two hospitals and five surrogates were presented with six hypothetical scenarios with a randomly assigned sequence: verbal and written summary, graph, table, photo, video, and pamphlet. The majority (76%) of respondents chose the traditional verbal communication of prognosis by their doctor with a written summary as a reference and to share with family; the second choice was a condition-specific pamphlet (63%). Many found the graph and photo to be distressing (36% and 42%, respectively). Most (71%) wanted to know everything about their condition trajectory, and 63% chose shared decision making rather than completely autonomous or full delegation to clinicians or family. There were no gender differentials between wanting to know it all, supporting shared decision making or the preferred format for breaking news ( > 0.05). Older hospitalized patients with chronic conditions are willing to discuss end-of-life issues, learn about their prognosis, and be involved in shared decision making. Innovative formats such as graphs, videos, or photos were not welcome as part of the prognostic discussion.
临终时的共同决策是一项平衡的工作，既要向患者及其代理人/家属传达预后信息，又要让他们参与考虑符合价值观的管理选择。这项横断面调查旨在确定患有慢性疾病的老年患者更倾向于以何种形式接收关于其治疗选择和疾病进展的预后信息，以及他们期望参与决策的程度。参与率为60%，两所医院的139名住院患者和5名代理人被随机分配了六种假设情景：口头和书面总结、图表、表格、照片、视频和宣传册。大多数（76%）受访者选择医生以口头方式传达预后，并以书面总结作为参考，以便与家人分享；其次是特定病情的宣传册（63%）。许多人认为图表和照片令人痛苦（分别为36%和42%）。大多数（71%）人想了解自己病情的所有情况，63%的人选择共同决策，而不是完全自主决策或完全委托给临床医生或家人。在想了解全部情况、支持共同决策或接收坏消息的首选形式方面，不存在性别差异（>0.05）。患有慢性疾病的老年住院患者愿意讨论临终问题，了解自己的预后，并参与共同决策。图表、视频或照片等创新形式作为预后讨论的一部分并不受欢迎。
