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Level of Care Preferences Among Nursing Home Residents With Advanced Dementia
Mitchell SL, Palmer JA, Volandes AE, Hanson LC, Habtemariam D, Shaffer ML.. Journal of pain and symptom management, 2017-08-08
Topic: Risk, prevention and care in population studies
Context Delivering goal-directed care is a hallmark of high-quality palliative care, but requires an understanding of preferences. Objectives To describe and identify factors associated with level of care preferences among proxies of nursing home (NH) residents with advanced dementia. Methods NH residents with advanced dementia and their proxies (N = 402 dyads) were recruited from 62 Boston-area facilities as part of an ongoing randomized clinical trial. At baseline, all proxies were asked to select which level of care they felt the resident should receive: intensive, basic, or comfort care. Multivariable logistic regression identified resident and proxy factors associated with a preference for comfort care (vs. basic or intensive medical care). Results Proxy level of care preferences were: comfort, 62.2%; basic, 31.1%; and intensive medical care, 6.5%. In multivariable analyses, proxy perception that the resident had less than six months to live was most strongly associated with a preference for comfort-focused care (adjusted odds ratio 12.25, 95% CI 4.04-37.08). Additional factors significantly associated with a preference for comfort care included older resident age, worse resident cognitive impairment, and the proxy having been asked about goals of care preferences by a NH health care provider (adjusted odds ratio 1.71, 95% CI 1.07, 2.74). Conclusion Most proxies select comfort as the preferred level of care for NH residents with advanced dementia. Discussions regarding prognosis, as well as inquiry about goals of care, are modifiable factors that may promote a preference for comfort care in this population.
Key findings
- Objectives To describe and identify factors associated with level of care preferences among proxies of nursing home (NH) residents with advanced dementia.
- Multivariable logistic regression identified resident and proxy factors associated with a preference for comfort care (vs. basic or intensive medical care).
- Results Proxy level of care preferences were: comfort, 62.2%; basic, 31.1%; and intensive medical care, 6.5%.
- In multivariable analyses, proxy perception that the resident had less than six months to live was most strongly associated with a preference for comfort-focused care (adjusted odds ratio 12.25, 95% CI 4.04-37.08).
- Additional factors significantly associated with a preference for comfort care included older resident age, worse resident cognitive impairment, and the proxy having been asked about goals of care preferences by a NH health care provider (adjusted odds ratio 1.71, 95% CI 1.07, 2.74).
Study details
- Participants402
- Effect size62.2%; 31.1%; 6.5%
- Evidence strengthHigh
How this study scored 78/100
Published in a peer-reviewed journal, and it is a randomised controlled trial. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 45 of the 58 points we could judge it on, which is 78 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of pain and symptom management) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 11 / 12 | A randomised controlled trial (from PubMed type “Randomized Controlled Trial”) |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2017 — within 10 year(s) of the newest study here |
| Sample size | 2 / 4 | 402 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 1 / 2 | Randomised (as stated in the record) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 28797857) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 45 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 45 of the 58 points we could judge it on is 78 out of 100. |
| Total | 78 / 100 | — |
What each of these 20 components measures, and what this score is not →
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APA 7th
Mitchell, S. L., Palmer, J. A., Volandes, A. E., Hanson, L. C., Habtemariam, D., & Shaffer, M. L. (2017). Level of Care Preferences Among Nursing Home Residents With Advanced Dementia. Journal of pain and symptom management. https://doi.org/10.1016/j.jpainsymman.2017.04.020
Vancouver
Mitchell SL, Palmer JA, Volandes AE, Hanson LC, Habtemariam D, Shaffer ML. Level of Care Preferences Among Nursing Home Residents With Advanced Dementia. Journal of pain and symptom management. 2017. doi:10.1016/j.jpainsymman.2017.04.020. PMID: 28797857.
BibTeX
@article{mitchell2017-28797857,
author = {Mitchell, S. L. and Palmer, J. A. and Volandes, A. E. and Hanson, L. C. and Habtemariam, D. and Shaffer, M. L.},
title = {{Level of Care Preferences Among Nursing Home Residents With Advanced Dementia}},
journal = {Journal of pain and symptom management},
year = {2017},
doi = {10.1016/j.jpainsymman.2017.04.020},
pmid = {28797857},
url = {https://doi.org/10.1016/j.jpainsymman.2017.04.020}
}