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Titolo:
VALIDATION OF PREFERENCES FOR LIFE-SUSTAINING TREATMENT - IMPLICATIONS FOR ADVANCE CARE PLANNING
Autore:
PATRICK DL; PEARLMAN RA; STARKS HE; CAIN KC; COLE WG; UHLMANN RF;
Indirizzi:
UNIV WASHINGTON,DEPT HLTH SERV,BOX 357660 SEATTLE WA 98195 VET AFFAIRS PUGET SOUND HLTH CARE SYST SEATTLE WA 98108 UNIV WASHINGTON,DEPT MED SEATTLE WA 98195
Titolo Testata:
Annals of internal medicine
fascicolo: 7, volume: 127, anno: 1997,
pagine: 509 -
SICI:
0003-4819(1997)127:7<509:VOPFLT>2.0.ZU;2-G
Fonte:
ISI
Lingua:
ENG
Soggetto:
STATES WORSE; DIRECTIVES; ATTITUDES; STABILITY; CHOICES; QUALITY; VALUES; DEATH;
Keywords:
ADVANCE DIRECTIVES; LIFE SUPPORT CARE; HEALTH STATUS; TREATMENT OUTCOMES;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
25
Recensione:
Indirizzi per estratti:
Citazione:
D.L. Patrick et al., "VALIDATION OF PREFERENCES FOR LIFE-SUSTAINING TREATMENT - IMPLICATIONS FOR ADVANCE CARE PLANNING", Annals of internal medicine, 127(7), 1997, pp. 509

Abstract

Background: Treatment preferences established before life-threateningillness occurs may differ from actual decisions because of changes inpreferences or poor understanding of the link between prospective preferences and outcomes. Objective: To evaluate the validity of prospective treatment preferences by examining their concordance with ratings of health states. Design: Survey of seven cohorts of persons with diverse health status. Home-and hospital-based interviews were conducted at baseline and at 6, 18, and 30 months. Setting: The greater Seattle area. Participants: Younger and older well adults; persons with chronicconditions, terminal cancer, or AIDS; stroke survivors; and nursing home residents. Measurements: Concordance between six treatment preferences and five health state ratings (on a seven-point scale) was assessed by using logistic regression to measure the increase in odds of treatment refusal for each one-point change in health state ratings. Preferences were considered concordant if treatments were refused in health states rated as worse than death and were accepted in health states rated as better than death. Reasons for discordance were elicited at the final interview. Results: The probability of refusal of prospectivetreatment was strongly related to health state ratings. Odds ratios ranged from 1.7 to 1.9 (P < 0.001) for every treatment. When patients were shown their discordant preferences, they had a coherent explanation or changed their health state rating or treatment preference to makethe two concordant. Conclusions: Prospective life-sustaining treatment preferences show high convergent validity. For most persons, treatment preferences are grounded in a consistent belief system. Concordanceand discordance between treatment preferences and health state ratings offer clinicians the opportunity to explore patients' Values and reasoning.

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Documento generato il 23/09/20 alle ore 09:17:27