提前护理规划,生命终点偏好和负担性护理:一个实用集群随机临床试验
Jennifer L Wolff1, Danny Scerpella1, Erin R Giovannetti2
1Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
JAMA internal medicine
|December 2, 2024
概括
"分享选择"干预措施增加了在初级保健中记录的生命终点偏好. 然而,这也导致了临终期患者的潜在负担更大的护理.
科学领域:
- 老年病的医生 老年病的医生
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 初级保健机构对于预先护理规划 (ACP) 至关重要.
- 需要有效的ACP干预措施来改善终身护理文档和患者的治疗结果.
研究的目的:
- 评估基于初级保健的多组件ACP干预措施 (SHARING选择) 对记录的终身偏好的影响.
- 评估干预对患者生命末期可能负担重重的护理的影响.
主要方法:
- 在两个卫生系统的初级保健实践中进行了一项实用集群随机临床试验.
- 干预包括邮寄信件,促进者支持,检查清单,患者门户访问和提前指示表.
- 测量结果包括生命终点偏好和接受潜在负担的护理的新文件.
主要成果:
- 分享选择干预显著增加了生命终端偏好的文档 (aOR,2.15).
- 这种干预与潜在的负担性护理的增加有关 (aOR,1.40).
- 在某些子组中,治疗效果减弱,包括黑人患者和痴呆症患者.
结论:
- "分享选择"干预措施有效地增加了初级保健中生命终端偏好的记录.
- 干预还无意中增加了潜在的负担性生命终端护理,突出了全面支持的需要.
- 未来的研究应该优先考虑与患者相关的结果和对严重疾病管理的全面支持.
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