一项信息表干预支持痴呆症患者机械通气替代决策的初步研究

文献信息

中文摘要

背景： 吸入性肺炎是晚期痴呆症的常见并发症，可导致呼吸衰竭，从而需要就机械通气做出决策。尽管以舒适为重点的临终（EOL）目标已被确立，许多痴呆症患者仍接受机械通气，这凸显了改进决策支持的必要性。
目的： 开发并评估一项信息表干预。
方法： 我们报告了一项信息表干预的初步测试，该干预基于替代决策者和临床医生的定性反馈开发。替代决策者被随机分配到干预组或对照组；干预前/后结局在基线和八周随访时进行测量。
结果： 14名替代决策者入组（93%），13名完成了研究（93%；对照组=4，干预组=9），表明可行性。替代决策者认为信息表可接受（平均=3.3/4，SD=0.93），并表达了积极反馈。干预组的知识有所提高（Cohen's d=1.08，p=0.01），而对照组保持不变。随访时其他结局无差异。
结论： 该信息表干预可行、可接受，并提高了替代决策者在准备临终讨论方面对痴呆症的知识。

英文摘要

BACKGROUND: Aspiration pneumonia is a common complication of advanced dementia that can lead to respiratory failure requiring decisions about mechanical ventilation. Despite comfort-focused end-of-life (EOL) goals, many people with dementia receive mechanical ventilation, highlighting the need for improved decision-making support.
OBJECTIVES: To develop and evaluate an information sheet intervention.
METHODS: We report pilot testing of an information sheet intervention, developed using qualitative feedback from surrogates and clinicians. Surrogates were randomized to intervention or control groups; pre/post-intervention outcomes were measured at baseline and eight-week follow-up.
RESULTS: Fourteen surrogates enrolled (93%), and 13 completed the study (93%; control = 4, intervention = 9) demonstrating feasibility. Surrogates found the information sheet acceptable (mean = 3.3/4, SD = 0.93) and expressed positive feedback. Knowledge improved in the intervention group (Cohen's d = 1.08, p = 0.01) and remained unchanged among controls. No other outcomes differed at follow-up.
CONCLUSION: The information sheet intervention was feasible, acceptable, and improved surrogates' knowledge of dementia in preparing for EOL discussions.