晚期护理规划中的差异:探索因素、结果和公平性

IF 2.5 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Toni-Ann J'nelle Lewis Degrees MD, MPH, Fatiah Joseph MD, Michael E. Kaiser MD, MPH, Gabriella J. Phillip MD, Joshua Green DPM, Francin Alexis MD, Louis Mudannayake MD, Anna Goehring MD, Kwesi Blackman MD, MBA, David Conner MD, MPH, William M. Briggs PhD
{"title":"晚期护理规划中的差异:探索因素、结果和公平性","authors":"Toni-Ann J'nelle Lewis Degrees MD, MPH,&nbsp;Fatiah Joseph MD,&nbsp;Michael E. Kaiser MD, MPH,&nbsp;Gabriella J. Phillip MD,&nbsp;Joshua Green DPM,&nbsp;Francin Alexis MD,&nbsp;Louis Mudannayake MD,&nbsp;Anna Goehring MD,&nbsp;Kwesi Blackman MD, MBA,&nbsp;David Conner MD, MPH,&nbsp;William M. Briggs PhD","doi":"10.1016/j.jnma.2024.07.050","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><p>ACP is pivotal in patient care. It emphasizes respecting an individual's values, preferences, and goals in decision-making. Although ACP is beneficial to patients and families, disparities persist, particularly among marginalized groups. We undertook this study to assess these disparities between ACP among patients of various groups and evaluate the relationship between these factors on shared-decision making.</p></div><div><h3>Methods</h3><p>A retrospective cohort analysis collected data from a single facility spanning March to September 2023, focusing on palliative care encounters. Data were categorized by demographics (race, age, gender) and factors affecting patient and family decisions, including religion, marital status, diagnosis, and ultimate choices (DNR/DNI, comfort-measures, hospice). We examined these variables through logistic regression models, chi-square tests, and F-tests (p &lt; 0.05) to uncover potential correlations with advanced care planning.</p></div><div><h3>Results</h3><p>End-stage dementia patients showed a significant association with the likelihood and probability of undergoing ACP. Patients opting for comfort-directed care, DNR/DNI, and hospice care correlated significantly with ACP. Interestingly, there was no statistically significant association (p-value &gt;0.05) between race, gender, marital status, religion, or age and the likelihood of undergoing ACP.</p></div><div><h3>Conclusion</h3><p>Our results diverge from past trends, showing diminished rates of ACP completion among specific ethnic and religious demographics. One potential rationale is the integration of social workers within our facility, actively engaging in ACP with patients. This approach facilitates early interventions and ensures comprehensive patient services across both outpatient and inpatient settings. Overcoming obstacles to ACP conversations and embracing diverse perspectives is essential to achieving equitable and compassionate end-of-life care.</p></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 4","pages":"Page 433"},"PeriodicalIF":2.5000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Disparities in Advanced Care Planning: Exploring Factors, Outcomes, and Equity\",\"authors\":\"Toni-Ann J'nelle Lewis Degrees MD, MPH,&nbsp;Fatiah Joseph MD,&nbsp;Michael E. Kaiser MD, MPH,&nbsp;Gabriella J. Phillip MD,&nbsp;Joshua Green DPM,&nbsp;Francin Alexis MD,&nbsp;Louis Mudannayake MD,&nbsp;Anna Goehring MD,&nbsp;Kwesi Blackman MD, MBA,&nbsp;David Conner MD, MPH,&nbsp;William M. Briggs PhD\",\"doi\":\"10.1016/j.jnma.2024.07.050\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><p>ACP is pivotal in patient care. It emphasizes respecting an individual's values, preferences, and goals in decision-making. Although ACP is beneficial to patients and families, disparities persist, particularly among marginalized groups. We undertook this study to assess these disparities between ACP among patients of various groups and evaluate the relationship between these factors on shared-decision making.</p></div><div><h3>Methods</h3><p>A retrospective cohort analysis collected data from a single facility spanning March to September 2023, focusing on palliative care encounters. Data were categorized by demographics (race, age, gender) and factors affecting patient and family decisions, including religion, marital status, diagnosis, and ultimate choices (DNR/DNI, comfort-measures, hospice). We examined these variables through logistic regression models, chi-square tests, and F-tests (p &lt; 0.05) to uncover potential correlations with advanced care planning.</p></div><div><h3>Results</h3><p>End-stage dementia patients showed a significant association with the likelihood and probability of undergoing ACP. Patients opting for comfort-directed care, DNR/DNI, and hospice care correlated significantly with ACP. Interestingly, there was no statistically significant association (p-value &gt;0.05) between race, gender, marital status, religion, or age and the likelihood of undergoing ACP.</p></div><div><h3>Conclusion</h3><p>Our results diverge from past trends, showing diminished rates of ACP completion among specific ethnic and religious demographics. One potential rationale is the integration of social workers within our facility, actively engaging in ACP with patients. This approach facilitates early interventions and ensures comprehensive patient services across both outpatient and inpatient settings. Overcoming obstacles to ACP conversations and embracing diverse perspectives is essential to achieving equitable and compassionate end-of-life care.</p></div>\",\"PeriodicalId\":17369,\"journal\":{\"name\":\"Journal of the National Medical Association\",\"volume\":\"116 4\",\"pages\":\"Page 433\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2024-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the National Medical Association\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0027968424001317\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the National Medical Association","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0027968424001317","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0

摘要

目的 ACP 在病人护理中举足轻重。它强调在决策过程中尊重个人的价值观、偏好和目标。虽然 ACP 对患者和家属有益,但差距依然存在,尤其是在边缘化群体中。我们开展了这项研究,以评估不同群体患者之间的 ACP 差异,并评估这些因素与共同决策之间的关系。方法回顾性队列分析收集了 2023 年 3 月至 9 月期间一家医疗机构的数据,重点关注姑息治疗。数据按人口统计学(种族、年龄、性别)和影响患者及家属决策的因素进行分类,包括宗教信仰、婚姻状况、诊断和最终选择(DNR/DNI、舒适措施、临终关怀)。我们通过逻辑回归模型、卡方检验和 F 检验(p < 0.05)对这些变量进行了研究,以发现它们与晚期护理规划之间的潜在关联。选择舒适护理、DNR/DNI 和临终关怀的患者与 ACP 显著相关。有趣的是,种族、性别、婚姻状况、宗教信仰或年龄与接受 ACP 的可能性之间没有统计学意义(p 值为 0.05)。其中一个可能的原因是我们的医疗机构整合了社会工作者,他们积极地与病人一起参与 ACP。这种方法有利于早期干预,并确保在门诊和住院环境中为患者提供全面的服务。克服 ACP 对话的障碍并接受不同的观点对于实现公平和富有同情心的临终关怀至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Disparities in Advanced Care Planning: Exploring Factors, Outcomes, and Equity

Purpose

ACP is pivotal in patient care. It emphasizes respecting an individual's values, preferences, and goals in decision-making. Although ACP is beneficial to patients and families, disparities persist, particularly among marginalized groups. We undertook this study to assess these disparities between ACP among patients of various groups and evaluate the relationship between these factors on shared-decision making.

Methods

A retrospective cohort analysis collected data from a single facility spanning March to September 2023, focusing on palliative care encounters. Data were categorized by demographics (race, age, gender) and factors affecting patient and family decisions, including religion, marital status, diagnosis, and ultimate choices (DNR/DNI, comfort-measures, hospice). We examined these variables through logistic regression models, chi-square tests, and F-tests (p < 0.05) to uncover potential correlations with advanced care planning.

Results

End-stage dementia patients showed a significant association with the likelihood and probability of undergoing ACP. Patients opting for comfort-directed care, DNR/DNI, and hospice care correlated significantly with ACP. Interestingly, there was no statistically significant association (p-value >0.05) between race, gender, marital status, religion, or age and the likelihood of undergoing ACP.

Conclusion

Our results diverge from past trends, showing diminished rates of ACP completion among specific ethnic and religious demographics. One potential rationale is the integration of social workers within our facility, actively engaging in ACP with patients. This approach facilitates early interventions and ensures comprehensive patient services across both outpatient and inpatient settings. Overcoming obstacles to ACP conversations and embracing diverse perspectives is essential to achieving equitable and compassionate end-of-life care.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
CiteScore
4.80
自引率
3.00%
发文量
139
审稿时长
98 days
期刊介绍: Journal of the National Medical Association, the official journal of the National Medical Association, is a peer-reviewed publication whose purpose is to address medical care disparities of persons of African descent. The Journal of the National Medical Association is focused on specialized clinical research activities related to the health problems of African Americans and other minority groups. Special emphasis is placed on the application of medical science to improve the healthcare of underserved populations both in the United States and abroad. The Journal has the following objectives: (1) to expand the base of original peer-reviewed literature and the quality of that research on the topic of minority health; (2) to provide greater dissemination of this research; (3) to offer appropriate and timely recognition of the significant contributions of physicians who serve these populations; and (4) to promote engagement by member and non-member physicians in the overall goals and objectives of the National Medical Association.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信