痴呆症患者及其护理伙伴的医疗决策经验:一种定性研究
Thalia Porteny1, Mary Lynch2, Audrey Covaleski2
1Department of Health Policy and Management, Mailman School of Public Health, Columbia University, 722 West 168th St, New York, NY, 10035, USA. tp2769@cumc.columbia.edu.
对于痴呆症患者 (PWD) 的医疗干预的决策经常忽视风险,影响生活质量. 改善与临床医生关于痴呆相关结果的沟通对于明智的选择和事先的护理规划至关重要.
科学领域:
- 老年学是一门学科.
- 医学伦理 医学伦理
- 定性研究是指质量研究.
背景情况:
- 痴呆症患者和照顾者面临着复杂的医疗决策,结果不确定.
- 现有的临床指南缺乏以患者为中心的决策和PWD预先护理计划的细节.
研究的目的:
- 探索PWD及其护理伙伴之间医疗和外科干预的决策过程.
- 确定影响决策质量的因素,并为临床指导提供信息.
主要方法:
- 使用主题分析进行定性研究.
- 与30名参与者 (9名PWD,21名护理伙伴) 进行了半结构化采访.
主要成果:
- 出现了四个主题:不同的决策方法,作为价值评估点的干预决策,缺乏对干预影响的临床讨论,以及决策质量的促进者 (信任,多学科团队).
- 随着认知能力的下降,护理伙伴在预先护理规划 (ACP) 中的参与增加了.
- 决策往往涉及影响生命终点和生活质量的权衡.
结论:
- PWD和护理伙伴根据痴呆症预后做出决定,但往往没有讨论医疗干预风险.
- 没有解决的风险可能会导致不良的生活质量后果.
- 临床医生必须讨论干预措施的痴呆相关风险,以改善决策和ACP.
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