Assessing Individual Preferences for End-of-Life Care

评估个人对临终关怀的偏好

• 批准号: 7140467
• 负责人: CINDY L BRYCE
• 金额: $ 15.71万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-30 至 2008-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7140467
• 关键词: behavioral /social science research tag; belief; caregivers; coping; data collection methodology /evaluation; decision making; ethics; health behavior; health care policy; health care professional practice; health care service availability; health care service evaluation; health care service utilization; health economics; health services research tag; human subject; interview; preference; psychological values; quality of life; questionnaires; religion; statistics /biometry; terminal patient care

DESCRIPTION (provided by applicant): A growing body of research has identified domains of good end-of-life (EOL) care, but few studies have quantified the values people place on quality of EOL domains and services. The typical approach applied to health care services to measure value requires estimating quality-adjusted life years (QALYs), but circumstances surrounding end of life suggest that QALYs may underestimate the value of EOL interventions. Through the R21 mechanism for exploratory research, the proposed study addresses 3 aims concerning the valuation of EOL care: Aim 1: Build and test a modified measurement tool that is appropriate for assessing preferences over domains of EOL care. Investigators will adapt current methods for eliciting preferences in a way that allows EOL care to be valued appropriately and incorporates both physical and emotional domains of EOL care. Aim 2: Use this measurement tool to assess the value for EOL care in 2 study cohorts (a general population cohort and a patient cohort) and compare differences in preferences between the 2 groups. Formal guidelines recommend that researchers use a societal (general population) perspective to facilitate comparisons across studies and services. Both societal- and patient-based perspectives are important and serve different functions, the former informing resource allocation decisions and the latter being relevant for individual treatment decisions. Investigators will compare values for the 2 cohorts, controlling for respondent characteristics. Aim 3: Conduct a pilot study to explore interactions between EOL domains. However useful it may be to consider the value of domains individually, domains are not independent and interrelationships among domains have implications for estimation procedures. The study will begin to explore simple interactions between domains in a small pilot study and again determine whether interactions differ for the 2 cohorts. This project will provide more robust estimates for the value of EOL services, which can then be compared with other services. By including large general population and patient-derived samples, it will underscore the need to account for both societal and patient values, especially when the 2 are dissimilar. In addition, exploring variability in values for EOL care as a function of respondent characteristics will enable providers to develop EOL care programs that address specific patient needs. Finally, exploring interactions among domains will help researchers better understand how improving (or otherwise changing) 1 domain will impact patients' EOL experiences.

描述（由申请人提供）：越来越多的研究已经确定了良好的寿命（EOL）护理领域，但是很少有研究量化了人们在EOL领域和服务质量上所占据的价值。典型的方法适用于衡量价值的典型方法，需要估算质量调整后的寿命（QALYS），但是围绕生命末端的情况表明，Qalys可能会低估EOL干预措施的价值。通过R21探索性研究的机制，拟议的研究针对EOL护理评估的目的3旨在：AIM 1：构建和测试一种适用于评估EOL护理领域偏好的修改测量工具。研究人员将以一种使EOL护理得到适当评估并纳入EOL护理的物理和情感领域的方式来调整当前方法，以使EOL护理得到适当的重视。 AIM 2：使用此测量工具评估2个研究队列（一般人群队列和一个患者队列）中EOL护理的价值，并比较两组之间的偏好差异。正式指南建议研究人员使用社会（一般人口）观点来促进研究和服务之间的比较。社会和基于患者的观点都很重要，并且发挥了不同的功能，前者为资源分配决策提供了信息，而后者与个人治疗决策有关。研究人员将比较两个队列的值，以控制受访者的特征。目标3：进行试点研究以探索EOL域之间的相互作用。但是，有用的可能是单独考虑域的价值，域不是独立的，并且域之间的相互关系对估计程序有影响。该研究将开始探索小型试点研究中域之间的简单相互作用，并再次确定两个队列的相互作用是否有所不同。该项目将为EOL服务的价值提供更强大的估计，然后将其与其他服务进行比较。通过包括大量的一般人群和患者衍生的样本，它将强调有必要考虑社会和患者价值观，尤其是在2个不同的情况下。此外，探索EOL护理值的变异性作为受访者特征的函数将使提供者能够制定满足特定患者需求的EOL护理计划。最后，探索领域之间的互动将有助于研究人员更好地了解1个领域（或其他变化）1域将如何影响患者的EOL体验。