Advance Care Planning and Decision Regret Among Stroke Surrogate Decision Makers: A Longitudinal Cohort Study.

IF 7.7 1区医学 Q1 CLINICAL NEUROLOGY

Neurology Pub Date : 2025-07-08 Epub Date: 2025-06-09 DOI:10.1212/WNL.0000000000213787

Darin B Zahuranec, Christopher J Becker, Lourdes Carhuapoma, Carmen Ortiz, Rebecca J Lank, Guanghao Zhang, Kevin He, Erin Case, Lewis B Morgenstern

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引用次数: 0

Abstract

Objectives: Investigate the association between advance care planning and decision regret among stroke surrogate decision makers.

Methods: People hospitalized with ischemic or hemorrhagic stroke and their surrogate decision makers were enrolled. Surrogates completed the validated decision regret scale (range 0-100, higher worse, analyzed as "any" vs "none") in the year after stroke (postdischarge, 3, 6, and 12 months). The association of advance care planning and regret was assessed with multilevel mixed effects logistic regression models, adjusted for prespecified covariates.

Results: Participants were 317 surrogates for 255 patients with stroke (enrolled April 2016 to October 2020). Patients had a mean age of 74.6 years and mean NIH Stroke Scale of 14.7, with 53% deceased at 3 months. Surrogate characteristics were mean age: 55.8 years, child of patient: 62%, and decision considered (do-not-resuscitate 36%, comfort care 16%, feeding tube 14%, mechanical ventilation 14%, brain surgery 10%, and other 10%). Overall, 132/317 (42%) surrogates reported formal advance care plans. Decision regret scores overall were low (postdischarge mean: 11.2). Formal written advance care plans were associated with lower odds of any decision regret (odds ratio 0.46, 95% CI 0.24-0.89, p = 0.02) after full adjustment.

Discussion: Formal written advance care plans were associated with lower odds of any decision regret among surrogate decision makers in the year after stroke.

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卒中代理决策者的提前护理计划和决策后悔：一项纵向队列研究。

目的：探讨卒中代理决策者的提前护理计划与决策后悔之间的关系。方法：纳入缺血性或出血性中风住院患者及其代理决策者。在中风后一年（出院后、3、6和12个月），受试者完成了有效的决策后悔量表（范围0-100，越高越差，分析为“有”vs“无”）。采用多水平混合效应逻辑回归模型评估提前护理计划和后悔的关系，并根据预先指定的协变量进行调整。结果：参与者是255名卒中患者的317名代理人（入组时间为2016年4月至2020年10月）。患者平均年龄74.6岁，NIH卒中量表平均14.7分，其中53%在3个月时死亡。代理人的特征为平均年龄：55.8岁，患儿占62%，考虑决定（不复苏36%，舒适护理16%，喂食管14%，机械通气14%，脑外科手术10%，其他10%）。总体而言，317名代孕母亲中有132名（42%）报告了正式的提前护理计划。决策后悔评分总体较低（出院后平均值：11.2）。在完全调整后，正式书面的预先护理计划与任何决定后悔的几率较低相关（优势比0.46,95% CI 0.24-0.89, p = 0.02）。讨论：在中风后的一年中，正式的书面提前护理计划与代理决策者的任何决定后悔的几率较低有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurology 医学-临床神经学

CiteScore

12.20

自引率

4.00%

发文量

1973

审稿时长

2-3 weeks

期刊介绍： Neurology, the official journal of the American Academy of Neurology, aspires to be the premier peer-reviewed journal for clinical neurology research. Its mission is to publish exceptional peer-reviewed original research articles, editorials, and reviews to improve patient care, education, clinical research, and professionalism in neurology. As the leading clinical neurology journal worldwide, Neurology targets physicians specializing in nervous system diseases and conditions. It aims to advance the field by presenting new basic and clinical research that influences neurological practice. The journal is a leading source of cutting-edge, peer-reviewed information for the neurology community worldwide. Editorial content includes Research, Clinical/Scientific Notes, Views, Historical Neurology, NeuroImages, Humanities, Letters, and position papers from the American Academy of Neurology. The online version is considered the definitive version, encompassing all available content. Neurology is indexed in prestigious databases such as MEDLINE/PubMed, Embase, Scopus, Biological Abstracts®, PsycINFO®, Current Contents®, Web of Science®, CrossRef, and Google Scholar.