Preferências para os cuidados no fim da vida: experimentos de escolhas discretas
Preferências para os cuidados no fim da vida: experimentos de escolhas discretas
Data
2020
Autores
Carlos, Nayara da Silva
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
RESUMO No Brasil, ainda há carência de estudos que identifiquem o padrão de preferências de nossa população em relação às escolhas relacionadas ao fim de vida. O termo “fim de vida” define o momento no qual foram esgotados todos os tratamentos capazes de reverter a doença e a morte torna-se iminente. O experimento de escolhas discretas (DCE) foi definido como método no estudo, e visa colaborar para a elucidação das preferências dos pacientes sobre fim de vida. Objetivo: Realizar um estudo piloto, que servirá de base para a realização de um DCE para avaliar as preferências de pacientes em relação às medidas extremas relacionadas aos cuidados dos pacientes em fim de vida. Método: O DCE foi o método escolhido para extrair os resultados de utilidade ou peso de preferências através de questionário aplicado aos pacientes do Instituto Nacional de Cardiologia (INC) com base em cenários hipotéticos, no qual eram apresentados 14 cenários, com 4 atributos e 3 níveis de atributos relacionados ao fim de vida. Sendo 2 desses cenários utilizados para testar a atenção e a compreensão dos respondedores. Os resultados das escolhas dos participantes frente aos atributos e níveis de atributos foram avaliados através do software R em um modelo condicional logístico. Resultados: Foram realizadas 44 entrevistas, nas quais os pacientes, em sua maioria homens (68%), apresentaram média de idade de 62 anos. No estudo em questão, os pacientes passaram pelo trade-off entre maior esforço terapêutico e tempo de sobrevida, com cerca de 65% dos pacientes preferindo investir no tratamento que prolongasse a vida. O DCE, conforme esperado, apresentou valores positivos para os atributos desejáveis como tempo de sobrevida (0,0112 e p <0,05) e negativos para atributos indesejáveis, como diálise (-0,0114 e p <0,05), CTI (-0,0161 e p <0,05) e ventilação mecânica (- 0,0002 e p >0,05). Esse estudo piloto resultou em novos cenários, e poderá servir como base para um DCE futuramente, colaborando para melhorar o entendimento das preferências dos pacientes em fim de vida. Discussão: Esse estudo piloto trouxe benefícios por já ter identificado alguns parâmetros com significado estatístico, mesmo tendo utilizado uma amostragem de 44 pacientes. Não identificamos em nossa busca, estudos utilizando o método de DCE para avaliar as preferências em fim de vida na América Latina. O resultado do estudo piloto foi uma nova proposta de exposição dos cenários de fim de vida para um DCE futuro, o qual possa apresentar validade externa aplicável à população brasileira.
ABSTRACT Brazil still has an absence of studies that identify the preference standard in our population related to patient role in end of life choices. The “end of life” term defines the momentum, which has exhausted all the treatments capable to revert it, and the death becomes imminent. The discrete choice experiment (DCE) was defined as the method of the study and aims to make patient´s preferences about end of life clearer. Objetive: To conduct a pilot study that will be a base for a DCE evaluating the patient’s preference relating to extreme measures of care with end of life patients. Method: The DCE was the chosen method for extracting the results of utility or weights of preferences through a questionnaire carried out at the National Institute of Cardiology (INC) to patients based on a hypothetical scenario, where they were presented 14 scenarios, with 4 attributes and 3 levels of attributes related to end of life. Two of these scenarios were applied to test the attention and comprehension of patients. The results of patients choices related to attributes and levels of attributes were evaluated though R software in a logistical conditional model. Results: Forty-four interviews were conducted, the majority of participants was men (68%) and presented a mean age of 62 years old. In this, actual study patients had to choose the trade-off between more therapeutic effort and time of survival, with around 65% of participants preferring to invest in treatment that could prolong their lives. The DCE, as expected, presented positive values for desirable attributes as time of survival (0.0112 e p <0.05) and negatives to undesirable attributes, as dialyses (- 0.0114 e p <0.05), CTI (-0.0161 e p <0.05) and mechanic ventilation (-0.0002 e p >0.05). This pilot study resulted in new scenarios, and serves as a base to future DCE, collaborating to improve the understanding of end of life preferences for patients. Discussion: This pilot study brought benefits because it has already identified some parameters with statistical significance, despite having only used a limited sample size of 44 patients. We did not identify in the literature search any study using DCE method for evaluating patients preferences in the end of life context in Latin America. The pilot study result was a new proposal for exposing the scenarios for end of life for a future DCE, which could present an external validity applicable to the Brazilian population.
ABSTRACT Brazil still has an absence of studies that identify the preference standard in our population related to patient role in end of life choices. The “end of life” term defines the momentum, which has exhausted all the treatments capable to revert it, and the death becomes imminent. The discrete choice experiment (DCE) was defined as the method of the study and aims to make patient´s preferences about end of life clearer. Objetive: To conduct a pilot study that will be a base for a DCE evaluating the patient’s preference relating to extreme measures of care with end of life patients. Method: The DCE was the chosen method for extracting the results of utility or weights of preferences through a questionnaire carried out at the National Institute of Cardiology (INC) to patients based on a hypothetical scenario, where they were presented 14 scenarios, with 4 attributes and 3 levels of attributes related to end of life. Two of these scenarios were applied to test the attention and comprehension of patients. The results of patients choices related to attributes and levels of attributes were evaluated though R software in a logistical conditional model. Results: Forty-four interviews were conducted, the majority of participants was men (68%) and presented a mean age of 62 years old. In this, actual study patients had to choose the trade-off between more therapeutic effort and time of survival, with around 65% of participants preferring to invest in treatment that could prolong their lives. The DCE, as expected, presented positive values for desirable attributes as time of survival (0.0112 e p <0.05) and negatives to undesirable attributes, as dialyses (- 0.0114 e p <0.05), CTI (-0.0161 e p <0.05) and mechanic ventilation (-0.0002 e p >0.05). This pilot study resulted in new scenarios, and serves as a base to future DCE, collaborating to improve the understanding of end of life preferences for patients. Discussion: This pilot study brought benefits because it has already identified some parameters with statistical significance, despite having only used a limited sample size of 44 patients. We did not identify in the literature search any study using DCE method for evaluating patients preferences in the end of life context in Latin America. The pilot study result was a new proposal for exposing the scenarios for end of life for a future DCE, which could present an external validity applicable to the Brazilian population.
Description
Palavras-chave
End of life, Palliative care, Terminal care, Patient preference, Discrete choice, Fim de vida, Cuidados paliativos, Doença terminal, Preferências dos pacientes, Experimento de escolhas discretas
Citação
Carlos, NS. Preferências para os cuidados no fim da vida: experimentos de escolhas discretas. Rio de Janeiro. Dissertação [Mestrado Profissional em Avaliação de Tecnologias em Saúde] - Instituto Nacional de Cardiologia; 2020.