Intervention thresholds: a conceptual frame for advance care planning choices

BMC Palliative Care

Research Article

Karen G Scandrett¹  Brian Joyce¹  Linda Emanuel² 

[1] Northwestern University, Buehler Center on Aging, Health & Society, Chicago, Illinois, USA;Northwestern University, Buehler Center on Aging, Health & Society, Chicago, Illinois, USA;General Internal Medicine, 750 N. Lake Shore Drive, Suite 601, 60611, Chicago, Illinois, USA;

关键词: End-of-life;    Advance care planning;    Decision making;   

DOI  :  10.1186/1472-684X-13-21

 received in 2014-01-17, accepted in 2014-04-04,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundAdvance care planning (ACP) provides for decisions in the event of decisional incapacity. Determining ahead of time what a person may want is challenging and limits the utility of ACP. We present empirical evidence for a new approach to ACP: the individual’s “intervention threshold.” The intervention threshold is intuitively understood by clinicians and lay people, but has not been thoroughly described, measured, or analyzed.MethodsUsing a mixed-methods approach to address the concept of the intervention thresholds, we recruited 52 subjects from a population of chronically ill outpatients for structured telephone interviews assessing knowledge, attitudes, and prior ACP activities. Respondents were presented with 11 interventions for each of four medical scenarios. For each scenario, they were asked whether they would accept each intervention. Data was evaluated by descriptive statistics and chi-squared statistics.ResultsComplete data were obtained from 52 patients, mean age of 64.5, 34.6% of whom were male. Only 17.3% reported prior ACP discussion with a physician. Rates of accepting and refusing interventions varied by scenario (p < 0.0001) and intervention intensity (p < 0.0001).ConclusionsThese data provide evidence that people display transitions between wanting or not wanting interventions based on scenarios. Further research is needed to determine effective ways to identify, measure, and represent the components of an individual’s intervention threshold in order to facilitate informed decision making during future incapacity.

【 授权许可】

Unknown   
© Scandrett et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.