Frailty, severity, progression and shared decision-making: A pragmatic framework for the challenge of clinical complexity at the end of life

被引:31
作者
Amblas-Novellas, J. [1 ,2 ,3 ]
Espaulella, J. [1 ,2 ,3 ]
Rexach, L. [4 ]
Fontecha, B. [5 ]
Inzitari, M. [6 ]
Blay, C. [3 ,7 ]
Gomez-Batiste, X. [3 ]
机构
[1] Hosp Univ Santa Creu, Geriatr & Palliat Care Dept, Barcelona, Spain
[2] Hosp Univ Vic, Barcelona, Spain
[3] Univ Vic, Chair & Dept Palliat Care, Barcelona, Spain
[4] Hosp Ramon & Cajal, Geriatr & Palliat Care Dept, Madrid, Spain
[5] Hosp Llobregat, Geriatr Dept Consorci Sanitari Integral, Barcelona, Spain
[6] Univ Autonoma Barcelona, E-08193 Barcelona, Spain
[7] Govt Catalonia, Dept Hlth, Programme Prevent & Care Patients Chron Condit, Catalonia, Spain
关键词
End of life; Complex decisions; Situational diagnosis; Frailty; Shared decision-making; COMPREHENSIVE GERIATRIC ASSESSMENT; PALLIATIVE CARE; OLDER-ADULTS; ELDERLY-PEOPLE; INDEX; INSTRUMENTS; PHENOTYPE; DEMENTIA; OUTCOMES; FITNESS;
D O I
10.1016/j.eurger.2015.01.002
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
The current epidemiological context features progressive ageing of the population and an increasing number of multi-morbid persons mostly affected by advanced chronic diseases. This perspective determines an urgency to improve decision-making, which becomes especially difficult due to the clinical uncertainty of life final stages. Usual approaches based on clinical practice guidelines and focused on the prognosis may be useful in a population approach, but will probably be insufficient against the clinical complexity arising from individualized decision-making. For this reason, we propose a pragmatic framework as a more comprehensive base to guide decision-making and helping the dialogue between patient, family and professionals in regards to expectations and objectives in the shared-decision process. This framework requires two stages: (1) an adequate situational diagnosis and (2) the build-up of shared decision-making contexts by involving patients in the process. To determine situational diagnosis, we propose a model that combines elements of background knowledge on geriatrics and palliative care, including the scientific evidence-(from prognostic markers and analysis of frailty based on the accumulation of deficits), and clinical experience (assessment of the variables taking into account both static-severity-and dynamic-progression-behaviour). For decision making, we incorporate the model of person-centred care based on shared decision-making, understood as a collaborative process between patients and professionals to identify needs, set objectives, develop and implement the care plan and monitor its evolution. Future studies will have to evaluate the validity and utility of this framework for decision making in elderly with advanced diseases at end-of-life. (C) 2015 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.
引用
收藏
页码:189 / 194
页数:6
相关论文
共 30 条
[1]  
[Anonymous], 2011, GSF PROGNOSTIC INDIC
[2]   Examining three frailty conceptualizations in their ability to predict negative outcomes for home-care clients [J].
Armstrong, Joshua J. ;
Stolee, Paul ;
Hirdes, John P. ;
Poss, Jeff W. .
AGE AND AGEING, 2010, 39 (06) :755-758
[3]   Shared decision-making in palliative care: A systematic mixed studies review using narrative synthesis [J].
Belanger, Emmanuelle ;
Rodriguez, Charo ;
Groleau, Danielle .
PALLIATIVE MEDICINE, 2011, 25 (03) :242-261
[4]  
Boyd K., 2011, SUPPORTIVE PALLIATIV, P12
[5]   Spotlight: Palliative Care Beyond Cancer Recognising and managing key transitions in end of life care [J].
Boyd, Kirsty ;
Murray, Scott A. .
BRITISH MEDICAL JOURNAL, 2010, 341 :649-652
[6]   The frailty phenotype and the frailty index: different instruments for different purposes [J].
Cesari, Matteo ;
Gambassi, Giovanni ;
van Kan, Gabor Abellan ;
Vellas, Bruno .
AGE AND AGEING, 2014, 43 (01) :10-12
[7]   Frailty in elderly people [J].
Clegg, Andrew ;
Young, John ;
Iliffe, Steve ;
Rikkert, Marcel Olde ;
Rockwood, Kenneth .
LANCET, 2013, 381 (9868) :752-762
[8]  
Coulter A., 2013, Building the house of care, P1
[9]  
Coulter A, 2011, Making Shared Decision Making a Reality: No decision about me, without me
[10]   The risk of adverse outcomes in hospitalized older patients in relation to a frailty index based on a comprehensive geriatric assessment [J].
Evans, Stephen J. ;
Sayers, Margaret ;
Mitnitski, Arnold ;
Rockwood, Kenneth .
AGE AND AGEING, 2014, 43 (01) :127-132