RESUMO
OBJECTIVE: To measure the stability of life-sustaining treatment preferences amongst older people and analyse the factors that influence stability. DESIGN: Longitudinal cohort study. SETTING: Primary care centres, Granada (Spain). Eighty-five persons age 65 years or older. Participants filled out a questionnaire with six contexts of illness (LSPQ-e). They had to decide whether or not to receive treatment. Participants completed the questionnaire at baseline and 18 months later. RESULTS: 86 percent of the patients did not change preferences. Sex, age, marital status, hospitalisation, and self-perception of health and pain did not affect preferences. Morbidity and the death of a relative did. CONCLUSION: Stability of preferences of older persons in relation to end-of-life decisions seems to be more probable than instability. Some factors, such as the death of a relative or the increase in morbidity, can change preferences. These findings have implications for advance directives (ADs) and advance care planning.
Assuntos
Planejamento Antecipado de Cuidados , Cuidados para Prolongar a Vida , Preferência do Paciente , Idoso , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Análise Multivariada , EspanhaRESUMO
The accuracy of proxies when they interpret advance directives or apply substituted decision-making criteria has been called into question. It therefore became important to know if the Andalusian Advance Directive Form (AADF) can help to increase the accuracy of proxies' predictions. The aim of this research was to compare the effect of the AADF on the accuracy of proxies' predictions about patients' preferences with that gained from informative and deliberative sessions about end-of-life decision making. A total of 171 pairs of patients and their proxies were randomized to three groups. The control group's answers to the Life Sustaining Preferences Questionnaire (LSPQ) were compared with their proxies' answers to the same questionnaire. In one intervention group, the patients had already completed the AADF and given it to their proxies, who used it to guide their own answers to the LSPQ. In the second intervention (discussion) group, both patients and proxies attended two educative sessions guided by trained nurses and later filled in the LSPQ. Comparisons of accuracy and other variables showed a strong association with the discussion group. The findings show that promoting communication between patients and their proxies improves the accuracy of proxies' predictions much more than isolated use of the AADF form.
Assuntos
Diretivas Antecipadas , Satisfação do Paciente , Procurador , Idoso , Tomada de Decisões , Feminino , Humanos , Cuidados para Prolongar a Vida , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , EspanhaRESUMO
OBJECTIVE: To validate the Life-Support Preferences Questionnaire (LSPQ) for its use in Spain. DESIGN: Three-stage study: a) translation and linguistic adaptation; b) evaluation of its validity; and c) validation of its psychometric properties. SETTING: Nine primary care nursing clinics and 2 university classes in Granada, Spain. PARTICIPANTS: Patients who were of age and were first- or second-year university students, without any cognitive deterioration. MAIN MEASUREMENTS: The equivalence of the translation and the original was checked by bilingual people; its linguistic and grammatical standard was appraised by experts in Spanish. The validity of the questionnaire was evaluated by 15 judges-experts and 20 patients; linguistic complexity (Szigriszt index); stability in time (McNemar test); internal consistency (Cronbach's alpha). RESULTS: a) 2 bilingual people did a translation that was reviewed by 6 experts in Spanish. After alterations suggested by the experts, the bilingual people ratified its equivalence with the original; b) 15 experts affirmed that each item was a good indicator of care preferences at the end of life; c) 20 users confirmed the acceptability and comprehensibility of the questionnaire; d) reliability: 299 participants out of the 369 initially selected filled in the questionnaire; and e) its stability was 0.92; and its internal consistency, 0.85. CONCLUSION: The LSPQ questionnaire in Spanish (LSPQ-e) is a reliable tool, designed to help patients to clarify their care and treatment preferences at the end of their lives.
Assuntos
Cuidados para Prolongar a Vida , Inquéritos e Questionários , Adulto , Feminino , Humanos , Masculino , EspanhaRESUMO
Objetivo. Validar el Cuestionario de Preferencias de Soporte Vital (LSPQ ) para su uso en población española. Diseño. Estudio realizado en tres fases: a) traducción y adaptación idiomática; b) evaluación de su validez, y c) validación de sus propiedades psicométricas. Emplazamiento. El estudio se ha llevado a cabo en 9 consultas de enfermería de atención primaria y en 2 aulas universitarias de Granada. Participantes. Se incluyeron pacientes mayores de edad y estudiantes universitarios de primer y segundo cursos, sin deterioro cognitivo. Mediciones principales. Equivalencia de la traducción con el original verificada por bilingües. Corrección lingüística y gramatical evaluada por expertos en lengua española. Validez del cuestionario evaluada por 15 jueces-expertos y 20 pacientes. Complejidad lingüística (índice de Szigriszt). Estabilidad temporal (test de McNemar). Consistencia interna (alfa de Cronbach). Resultados. a) 2 personas bilingües realizaron una traducción que fue revisada por 6 expertos en lengua española. Tras las modificaciones que sugirieron, las personas bilingües aseguraron su equivalencia con el original; b) 15 expertos afirmaron que cada ítem era buen indicador de las preferencias de cuidado al final de la vida; c) 20 usuarios confirmaron la aceptabilidad y comprensibilidad del cuestionario; d) en relación con la fiabilidad, completaron el cuestionario 299 participantes (de los 369 inicialmente seleccionados), y e) la estabilidad del cuestionario es de 0,92 y su consistencia interna de 0,85. Conclusión. El cuestionario LSPQ en español (LSPQ-e) es una herramienta fiable diseñada para ayudar a los pacientes a clarificar sus preferencias de cuidado y tratamiento al final de la vida
Objective. To validate the Life-Support Preferences Questionnaire (LSPQ) for its use in Spain. Design. Three-stage study: a) translation and linguistic adaptation; b) evaluation of its validity; and c) validation of its psychometric properties. Setting. Nine primary care nursing clinics and 2 university classes in Granada, Spain. Participants. Patients who were of age and were first- or second-year university students, without any cognitive deterioration. Main measurements. The equivalence of the translation and the original was checked by bilingual people; its linguistic and grammatical standard was appraised by experts in Spanish. The validity of the questionnaire was evaluated by 15 judges-experts and 20 patients; linguistic complexity (Szigriszt index); stability in time (McNemar test); internal consistency (Cronbach's alpha). Results. a) 2 bilingual people did a translation that was reviewed by 6 experts in Spanish. After alterations suggested by the experts, the bilingual people ratified its equivalence with the original; b) 15 experts affirmed that each item was a good indicator of care preferences at the end of life; c) 20 users confirmed the acceptability and comprehensibility of the questionnaire; d) reliability: 299 participants out of the 369 initially selected filled in the questionnaire; and e) its stability was 0.92; and its internal consistency, 0.85. Conclusion. The LSPQ questionnaire in Spanish (LSPQ-e) is a reliable tool, designed to help patients to clarify their care and treatment preferences at the end of their lives
