Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA.
J Palliat Med. 2023 Oct;26(10):1380-1385. doi: 10.1089/jpm.2022.0565. Epub 2023 Jun 19.
Little is known about the patient-reported quality of and satisfaction with advance care planning (ACP) conversations with surrogates and clinicians among English- and Spanish-speaking older adults, or the potential disparities associated with ACP communication satisfaction. To determine patients' perceived quality of and satisfaction with ACP surrogate/clinician conversations and associated patient characteristics. Cross-sectional baseline data were used from two ACP trials, 2013-2017. Outcomes included self-reported ACP conversation quality ("general" vs. "detailed") and communication satisfaction (5-point Likert scale). Associations were determined by chi-squared and -tests. Subjects were primary care patients ≥55 years with chronic/serious illness in the United States. Of 1398 patients, mean age was 65.6 years (±7.7), 46% women, 32% Spanish speaking, 34% had limited health literacy, and 589 (42%) reported conversations with surrogates and 216 (15%) with clinicians. Of these, less than half rated the conversations as detailed high quality (clinician: 43%; surrogate: 37%). Five-point communication satisfaction scores were higher with detailed versus general conversations (e.g., surrogates: 4.4 vs. 4.1, = 0.001; clinicians: 4.4 vs. 4.2, = 0.18) and more often reported by men versus women [(4.4 (0.8) vs. 4.0 (1.0), = 0.003]; those with adequate versus limited health literacy [4.4 (0.8) vs. 4.0 (0.9), = 0.002]; and English versus Spanish speakers [4.5 (0.7) vs. 3.5 (0.9), < 0.001]. Among English- and Spanish-speaking older adults, ACP conversations were infrequent and most were general in quality. Higher quality detailed conversations resulted in greater communication satisfaction. Interventions are needed to improve conversation quality, particularly for Spanish-speaking patients and those with limited health literacy. Trial Registrations: ClinicalTrials.gov identifiers: "Improving Advance Care Planning by Preparing Diverse Seniors for Decision Making (PREPARE)" NCT01990235 and "Preparing Spanish-Speaking Older Adults for Advance Care Planning and Medical Decision Making (PREPARE)" NCT02072941.
对于说英语和西班牙语的老年患者及其代理人与临床医生之间进行预先护理计划（ACP）对话的质量和满意度，以及与 ACP 沟通满意度相关的潜在差异，人们知之甚少。本研究旨在确定患者对 ACP 代理人/临床医生对话的感知质量和满意度，以及相关的患者特征。该研究使用了 2013 年至 2017 年两项 ACP 试验的横断面基线数据。结果包括自我报告的 ACP 对话质量（“一般”与“详细”）和沟通满意度（5 分李克特量表）。通过卡方检验和 t 检验确定关联。研究对象为美国≥55 岁、患有慢性/严重疾病的初级保健患者。在 1398 名患者中，平均年龄为 65.6 岁（±7.7），46%为女性，32%为西班牙语使用者，34%有一定的健康素养，589 名（42%）报告与代理人进行了对话，216 名（15%）与临床医生进行了对话。在这些患者中，不到一半的人认为对话具有详细的高质量（临床医生：43%；代理人：37%）。详细的沟通满意度评分高于一般沟通满意度评分（例如，代理人：4.4 比 4.1，=0.001；临床医生：4.4 比 4.2，=0.18），且更多的男性报告了详细的沟通满意度评分而非女性（4.4（0.8）比 4.0（1.0），=0.003）；健康素养足够的患者比健康素养有限的患者报告了更多的详细沟通满意度评分（4.4（0.8）比 4.0（0.9），=0.002）；以及英语使用者比西班牙语使用者报告了更多的详细沟通满意度评分（4.5（0.7）比 3.5（0.9），<0.001）。在说英语和西班牙语的老年患者中，ACP 对话很少，而且大多数都是一般质量。更高质量的详细对话会产生更高的沟通满意度。需要进行干预以提高对话质量，特别是针对西班牙语患者和健康素养有限的患者。临床试验注册：ClinicalTrials.gov 标识符：“通过为决策制定做好准备来改善预先护理计划（PREPARE）”NCT01990235 和“为西班牙语裔老年人准备预先护理计划和医疗决策（PREPARE）”NCT02072941。
