Ozdemir Semra, Ng Sean, Chaudhry Isha, Malhotra Chetna, Finkelstein Eric Andrew
Signature Programme in Health Services and Systems Research, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore.
Duke University Global Health Institute, Durham, North Carolina, USA.
Cancer. 2023 May 1;129(9):1443-1452. doi: 10.1002/cncr.34684. Epub 2023 Feb 11.
This study aimed to examine (1) the evolution of patients-caregiver dyad decision-making role preferences over 3 years and the predictors of these preferences; and (2) discordance in decision-making role preferences among dyads.
A total of 311 patients with advanced solid cancer and their caregivers in Singapore reported their preferences for decision-making roles every 3 months. The predictors for decision-making role preferences among dyads were identified via the actor-partner interdependence framework using a mixed-effect ordered logistic model.
The proportion of patients and caregivers preferring patient-led decision-making was higher at the end of third year compared to baseline (patients: 40% vs. 20%, p value <.01; caregivers: 33% vs. 21%, p value = .03). Patients with female (odds ratio [OR], 1.74; p value <.01) and older (1-year OR, 1.02; p value <.01) caregivers and younger patients (1-year OR, 0.97; p value <.01) preferred higher involvement in decision-making. Caregivers with tertiary education (vs. lower education) (OR, 1.59; p value = .02) and those who accurately understood patients' treatment goals (OR, 1.37; p value = .01) preferred greater patient involvement in decision-making. Conversely, caregivers of female patients (OR, 0.68; p value = .03) and younger patients (1-year OR, 0.98; p value <.01) preferred lesser patient involvement in decision-making. The proportion of patient-caregiver dyads with discordance in preferred decision-making was lower at the end of the third year (51%) compared to baseline (68%) (p value <.01).
Despite a reduction in the proportion of dyads with discordance toward the end-of-life, the percentage with discordance remained high throughout the illness trajectory. Interventions facilitating open communication between dyads should be pursued in efforts to decrease dyadic discordance.
本研究旨在探讨（1）患者-照顾者二元组决策角色偏好随3年时间的演变情况及其偏好的预测因素；以及（2）二元组中决策角色偏好的不一致性。
新加坡共有311名晚期实体癌患者及其照顾者，每3个月报告一次他们对决策角色的偏好。通过使用混合效应有序逻辑模型的行为者-伙伴相互依赖框架，确定二元组中决策角色偏好的预测因素。
与基线相比，第三年末倾向于患者主导决策的患者和照顾者比例更高（患者：40%对20%，p值<.01；照顾者：33%对21%，p值=.03）。有女性照顾者（优势比[OR]，1.74；p值<.01）、年龄较大的照顾者（1年OR，1.02；p值<.01）以及较年轻患者（1年OR，0.97；p值<.01）的患者更倾向于在决策中更多参与。接受高等教育（与低等教育相比）的照顾者（OR，1.59；p值=.02）以及那些准确理解患者治疗目标的照顾者（OR，1.37；p值=.01）更倾向于让患者更多参与决策。相反，女性患者（OR，0.68；p值=.03）和较年轻患者（1年OR，0.98；p值<.01）的照顾者更倾向于让患者较少参与决策。与基线（68%）相比，第三年末决策偏好不一致的患者-照顾者二元组比例较低（51%）（p值<.01）。
尽管临终时不一致二元组的比例有所下降，但在整个疾病过程中不一致的百分比仍然很高。应采取促进二元组之间开放沟通的干预措施，以努力减少二元组的不一致性。
