| Summary: | 碩士 === 國立臺北護理健康大學 === 護理研究所 === 107 === Heart failure is one of common chronic diseases in Taiwan. Once the disease progresses, the patient may face the decision-making about invasive therapy for heart failure, life-sustaining treatment and hospice care. Family care-givers play an essential role at the patient’s end-of-life decision making; and the concordance of patient's preference and family’s preference for their love one may reduce the stress for end-of-life care. The purpose of this cross-sectional study is to describe the preferences for life-sustaining treatment and hospice care, and the patient-family preference agreement and its associated factors in patients with advanced heart failure and paired family care-givers. A convenience sample of 70 dyads of patients with advanced heart failure and their families were recruited from cardiology units and outpatient clinics at a medical center in northern Taiwan. Patients and the family answered the structured questionnaire separately to measure disease prognosis, medical communication, patient-family communication, end-of-life care preferences and patients’ quality of life via Minnesoda Heart Failure Quality of Life Questionnaire. The patients had a mean age of 56.9 (±12.3). Most of them were male, married and had the high-school education or lower. The family were younger, and female, spouse at the large. Patients’ heart failure were diagnosed within five years, with LVEF 20% to 30%, and treated with cardiovascular drugs. The results indicated that 48.6% to 74.3% of the patients and 60.0% to 90.0% of family subjects preferred aggressive end-of-life care, including CPR, cardiac massage, intubation, ventilator, ICU care, suction, NG tube feeding, parental nutrition therapy and dialysis. However, most of the patient subjects (55.7%) and paired family (77.1%) preferred hospice care, as well. Congruence and association between patients’ and their families’ preference were low (Kappa=.089-.245; λ＝.028-.182). Multivariate logistic regression analysis revealed that only patients’ heart failure quality of life (OR=8.5) and physician-family discussion about remaining heart function (OR=7.9) were significantly associated with both patient and paired family preferring hospice care for the end-of-life care. This study suggested that interventions are needed to assist the family-physician, family-patient discussion about the disease progression, the care and treatment for end-stage heart failure, and to promote the advanced directive planning, so that family surrogates are able to respect patient's wishes at the end of life.
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