ABSTRACT
Objetivo. Explorar las preferencias de los ciudadanos sobre el tratamiento de soporte vital en situaciones sanitarias críticas. Método. Estudio transversal mediante encuesta a 306 participantes, seleccionados aleatoriamente de consultas de enfermería, centros culturales, residencias asistidas y aulas universitarias. Para medir las preferencias en el tratamiento ante situaciones sanitarias críticas se empleó el cuestionario Life Suport Preferences Questionnaire (LSPQ). Se realizó un análisis descriptivo, bivariante y multivariante de los datos. Resultados. La edad media de los participantes fue de 39,28 años y la desviación estándar (DE) de 24,52; el 29,1% de los encuestados eran varones y un 37% no tenía estudios o sólo estudios primarios. La edad se mostró inversamente correlacionada con la preferencia de aceptar tratamientos, de tal manera que los mayores de 55 años optan en menor medida por los tratamientos de soporte vital que los más jóvenes y ocurre lo mismo con los de menor nivel académico respecto a los de nivel superior. Entre varones y mujeres no se han encontrado diferencias. Ante enfermedades graves sin posibilidad de recuperación las preferencias son similares, hay un rechazo del tratamiento en todos los grupos de edad. Cuando hay posibilidad de recuperación o se trata de tratamientos no invasivos, las personas de 21 o más años prefieren recibir tratamiento. Conclusión. Existe una gran variabilidad entre la población a la hora de aceptar o rechazar el tratamiento de soporte vital. Es inadecuado considerar que consiste siempre en la aceptación de tratamientos a toda costa. Convendría divulgar el conocimiento y uso de las instrucciones previas como mejor vía para respetar la voluntad del paciente cuando no tenga la capacidad de expresarla personalmente (AU)
Objective. To explore citizens treatment preferences in critical health situations.Method. We performed a cross-sectional study through a questionnaire administered to 306 participants, randomlyselected from nursing consultations, cultural centers, nursing homes and the university. Treatment preferences in critical health situations were measured through the Life Support Preferences Questionnaire (LSPQ). A descriptive bivariate and multivariate analysis was performed.Results. The mean age of participants was 39.28 years (SD: 24.52), 37% had primary school or no education, and29.1% were male. Age was inversely correlated with accepting treatments; thus acceptance of life support measures was lower among participants older than 55 years than among the youngest participants and was also lower among those with a lower educational level than those with a higher educational level. No differences were found between men and women. In serious diseases with no possibility of recovery, all age groups rejected treatment. When there was the potential for recovery or for non-invasive treatments, participants aged 21 years old or older would prefer to be treated.Conclusion. There is wide variability among the population when accepting or rejecting life support treatment. The view that treatment should be accepted at all costs is inappropriate. Disseminating knowledge of advance directives and the use of these documents is recommended as the most effective way to respect patients wishes when they are unable to express themselves (AU)
Subject(s)
Humans , Resuscitation , Patient Acceptance of Health Care , Emergency Treatment/standards , Resuscitation Orders/ethics , Informed Consent , Age DistributionABSTRACT
BACKGROUND: Demand for home care services has increased considerably, along with the growing complexity of cases and variability among resources and providers. Designing services that guarantee co-ordination and integration for providers and levels of care is of paramount importance. The aim of this study is to determine the effectiveness of a new case-management based, home care delivery model which has been implemented in Andalusia (Spain). METHODS: Quasi-experimental, controlled, non-randomised, multi-centre study on the population receiving home care services comparing the outcomes of the new model, which included nurse-led case management, versus the conventional one. Primary endpoints: functional status, satisfaction and use of healthcare resources. Secondary endpoints: recruitment and caregiver burden, mortality, institutionalisation, quality of life and family function. Analyses were performed at base-line, and at two, six and twelve months. A bivariate analysis was conducted with the Student's t-test, Mann-Whitney's U, and the chi squared test. Kaplan-Meier and log-rank tests were performed to compare survival and institutionalisation. A multivariate analysis was performed to pinpoint factors that impact on improvement of functional ability. RESULTS: Base-line differences in functional capacity - significantly lower in the intervention group (RR: 1.52 95%CI: 1.05-2.21; p = 0.0016) - disappeared at six months (RR: 1.31 95%CI: 0.87-1.98; p = 0.178). At six months, caregiver burden showed a slight reduction in the intervention group, whereas it increased notably in the control group (base-line Zarit Test: 57.06 95%CI: 54.77-59.34 vs. 60.50 95%CI: 53.63-67.37; p = 0.264), (Zarit Test at six months: 53.79 95%CI: 49.67-57.92 vs. 66.26 95%CI: 60.66-71.86 p = 0.002). Patients in the intervention group received more physiotherapy (7.92 CI95%: 5.22-10.62 vs. 3.24 95%CI: 1.37-5.310; p = 0.0001) and, on average, required fewer home care visits (9.40 95%CI: 7.89-10.92 vs.11.30 95%CI: 9.10-14.54). No differences were found in terms of frequency of visits to A&E or hospital re-admissions. Furthermore, patients in the control group perceived higher levels of satisfaction (16.88; 95%CI: 16.32-17.43; range: 0-21, vs. 14.65 95%CI: 13.61-15.68; p = 0,001). CONCLUSION: A home care service model that includes nurse-led case management streamlines access to healthcare services and resources, while impacting positively on patients' functional ability and caregiver burden, with increased levels of satisfaction. TRIAL REGISTRATION: ISRCTN44054549.
