Faculty of Business and Economics (HEC), University of Lausanne, Lausanne, Switzerland
Faculty of Business and Economics (HEC), University of Lausanne, Lausanne, Switzerland.
BMJ Open. 2023 Jul 24;13(7):e071444. doi: 10.1136/bmjopen-2022-071444.
Medical decision-making at the end of life is common and should be as patient-centred as possible. Our study investigates older adults' preferences towards three medical treatments that are frequently included in advance directive forms and their association with social, regional and health characteristics.
A cross-sectional study using population-based data of wave 8 (2019/2020) of the Swiss component of the Survey of Health, Ageing and Retirement in Europe.
1430 adults aged 58 years and older living in Switzerland.
Three questions on the preferences regarding cardiopulmonary resuscitation (CPR); life-prolonging treatment in case of high risk of permanent mental incapacity; reduced awareness (sedation) to relieve unbearable pain and symptoms. Their associations with individuals' social, regional and health characteristics.
Most older adults expressed a wish to receive CPR (58.6%) and to forgo life-prolonging treatment in case of permanent mental incapacity (92.2%). Most older adults also indicated that they would accept reduced awareness if necessary to receive effective treatment for pain and distressing symptoms (59.2%). Older adults' treatment preferences for CPR and life-prolonging treatment differed according to sex, age, partnership status, linguistic region and health status, while willingness to accept reduced awareness for effective symptom treatment was more similarly distributed across population groups.
Simultaneous preferences for CPR and refusal of life-prolonging treatment might appear to be conflicting treatment goals. Considering individuals' values and motivations can help clarify ambivalent treatment decisions. Structured advance care planning processes with trained professionals allows for exploring individuals' motivations and values and helps to identify congruent care and treatment goals.
生命末期的医疗决策很常见，应尽可能以患者为中心。我们的研究调查了老年人对经常包含在预先指示表中的三种医疗治疗方法的偏好，以及这些偏好与社会、地区和健康特征的关系。
一项使用欧洲健康、衰老和退休调查（Survey of Health, Ageing and Retirement in Europe）瑞士部分第 8 波（2019/2020 年）的基于人群的横断面研究数据。
1430 名居住在瑞士的 58 岁及以上成年人。
关于心肺复苏术（CPR）的偏好的三个问题；在永久性精神障碍高风险情况下的延长生命治疗；减轻难以忍受的疼痛和症状的意识降低（镇静）。它们与个体的社会、地区和健康特征的关系。
大多数老年人表示希望接受心肺复苏术（58.6%）和在永久性精神障碍的情况下放弃延长生命的治疗（92.2%）。大多数老年人还表示，如果需要接受有效的疼痛和痛苦症状治疗，他们也会接受意识降低（59.2%）。老年人对心肺复苏术和延长生命治疗的治疗偏好因性别、年龄、伴侣状况、语言区和健康状况而异，而接受有效症状治疗的意识降低的意愿在人群组之间分布更为相似。
同时对心肺复苏术的偏好和对延长生命治疗的拒绝可能是相互冲突的治疗目标。考虑个人的价值观和动机可以帮助澄清矛盾的治疗决策。有受过训练的专业人员的结构化的预先护理计划过程可以探索个人的动机和价值观，并帮助确定一致的护理和治疗目标。
