Quality of death: assessing the importance placed on end-of-life treatment in the intensive-care unit.
Context: The value of good end-of-life (EOL) care could be underestimated if its effects are assessed using the standard metric of quality-adjusted survival, especially if the time horizon is limited to the duration of the EOL care. This issue is particularly problematic in the intensive-care unit (...
| Publicado en: | Medical Care Vol. 42; no. 5; pp. 423 - 432 |
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| Autores principales: | , , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Lippincott Williams & Wilkins
May2004
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106668569&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106668569 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00257079 21B jtl: Medical Care issn: 00257079 maglogo: N pubinfo: dt: May2004 vid: 42 iid: 5 pid: 433 pub: Lippincott Williams & Wilkins place: Baltimore, Maryland artinfo: ui: 106668569 106668569 NLM15083102 2004191470 10.1097/01.mlr.0000124245.62354.57 NLM15083102 106668569 ppf: 423 ppct: 9 formats: tig: atl: Quality of death: assessing the importance placed on end-of-life treatment in the intensive-care unit. aug: au: Bryce CL Loewenstein G Arnold RM Schooler J Wax RS Angus DC Bryce, Cindy L Loewenstein, George Arnold, Robert M Schooler, Jonathan Wax, Randy S Angus, Derek C affil: Department of Medicine, Modeling of Acute Illness (CRISMA) Laboratory, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA sug: subj: Critical Care Evaluation Quality of Health Care Terminal Care Evaluation Adult Age Factors Convenience Sample Data Analysis Software Data Analysis, Statistical Descriptive Statistics Female Funding Source Interviews Kruskal-Wallis Test Life Expectancy Male Multivariate Analysis P-Value Pennsylvania Regression Research Instruments Scales Spearman's Rank Correlation Coefficient Survey Research Human Adult: 19-44 years Female Male ab: Context: The value of good end-of-life (EOL) care could be underestimated if its effects are assessed using the standard metric of quality-adjusted survival, especially if the time horizon is limited to the duration of the EOL care. This issue is particularly problematic in the intensive-care unit (ICU) where death is frequent, care is difficult, and costs are high.Objectives: The objectives of this study were to test whether people would trade healthy life expectancy for better EOL care, to understand how much life expectancy they would trade relative to domains of good care, and to determine the association of respondent characteristics to time traded.Design and Subjects: We used a computerized survey instrument describing hypothetical patient experiences in the ICU used to assess attitudes of a general population sample (n = 104) recruited in Pittsburgh, Pennsylvania.Measures: We used life expectancy traded (from a baseline of 80 healthy years followed by a 1-month fatal ICU stay) for improving ICU care in 4 domains: pain and discomfort, daily surroundings, treatment decisions, and family support.Results: Three fourths of respondents (n = 78) were prepared to shorten healthy life for better EOL care. Median time traded in individual domains ranged from 7.2 to 7.7 months overall and 9.6 to 11.4 months when restricted to those willing to trade. Median time traded for improvement in all domains was 8.3 months overall and 24.0 months by those willing to trade. In multivariable analyses, respondents who were older, nonwhite, or had children traded significantly less time, whereas those who did not perceive the ICU to be a caring environment traded more time.Conclusions: Good EOL care is highly valued, both in terms of medical and nonmedical domains, as suggested by previous work and confirmed by our data showing respondents trading quantities of healthy life several times longer than the duration of the EOL period itself. The considerable interperson variation highlights the importance of soliciting individual preferences about EOL care. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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