Cardiopulmonary Resuscitation Preferences of People Receiving Dialysis
Cardiopulmonary Resuscitation Preferences of People Receiving Dialysis
复制标题
接受透析的人的心肺复苏偏好
DOI：
10.1001/jamanetworkopen.2020.10398
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发表时间：
2020-08-24
影响因子：
13.8
通讯作者：
O'Hare, Ann M.
中科院分区：
文献类型：
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作者：
Bernacki, Gwen M.;Engelberg, Ruth A.;O'Hare, Ann M.
问题：接受透析的患者的心肺复苏(CPR)偏好是否与他们对临终关怀的其他方面的问题的回答一致？在这项横断面调查研究的876名参与者中，大多数(84.2%)表示他们肯定或很可能想要心肺复苏。对CPR的偏好与所审查的临终关怀的其他领域中的一些，但不是全部相关；对关于临终关怀的这些其他方面的问题的回答并不总是与参与者的CPR偏好一致。这项横断面调查研究描述了接受透析的患者的心肺复苏偏好，以及这些偏好与他们对临终关怀的其他方面问题的回答是如何关联的。接受透析的患者的心肺复苏(CPR)偏好是否与他们的价值观和临终关怀的其他方面一致，这一重要性尚不清楚。目的描述血液透析患者的心肺复苏偏好，以及这些偏好与他们对临终关怀其他方面问题的反应之间的关系。设计、设置和参与者对2015年4月22日至2018年10月2日期间在美国2个大都市地区(华盛顿州西雅图和田纳西州纳什维尔)31个非营利性透析机构接受透析的患者进行连续抽样的横断面调查研究。本文的分析是在2018年12月至2020年4月期间进行的。受试者被要求回答这样一个问题：“如果你现在必须做出决定，如果你的心脏停止跳动，你会想要心肺复苏术吗？”那些表示他们可能或肯定想要心肺复苏的人被归类为更喜欢心肺复苏术。主要结果和测量这项研究调查了CPR偏好和其他治疗偏好、参与提前护理计划、价值观、理想死亡地点、对预后的期望、症状和姑息护理需求之间的关系。结果在受邀完成调查的1434人中，1009人同意参与，876人(61.1%)纳入分析队列。最终队列的平均年龄(SD)为62.6(14.0)岁；492名(56.2%)为男性，528名(60.3%)为白人。在876名参与者中，738名(84.2%)表示他们肯定或很可能想要CPR(CPR组)，555名(75.2%)想要机械通气，而138名不想要CPR(不复苏组)的人中有13名(9.4%)(P<；.001)。CPR组的738名参与者中共有249名(33.7%)与DNR组的138名参与者中的84名(60.9%)有记录的治疗偏好(P<；.001)。在对未来护理的价值观方面，CPR组171人(23.2%)比DNR组138人中5人(3.6%)重视延长生命(P<；.001)；CPR组320人(43.4%)比DNR组109人(79.0%)重视舒适(P<；.001)；CPR组247人(33.5%)比DNR组138人中24人(17.4%)不确定他们对未来护理的愿望(P<；.001)。CPR组207例(28.0%)考虑过停止透析，DNR组62例(44.9%)考虑过停止透析，181例(24.5%)VS 58例(42.0%)讨论过停止透析(P=.001)。未观察到CPR偏好与代孕决策者的记录、对临终关怀的想法或讨论、首选死亡地点、对预后的预期、报告的症状或姑息治疗需求之间的统计学意义上的关联。结论和相关性接受透析的患者的CPR偏好与临终关怀的其他方面有关，但不是全部。参与者如何回答有关临终关怀的这些其他方面的问题并不总是与他们的CPR偏好一致。需要更多的工作来将关于代码状态的讨论与关于患者的价值观、目标和对临终关怀的偏好的更广泛的对话结合起来。
Question Do the cardiopulmonary resuscitation (CPR) preferences of patients receiving dialysis align with their responses to questions about other aspects of end-of-life care? Findings Among 876 participants in this cross-sectional survey study, most (84.2%) indicated they would definitely or probably want CPR. Preference for CPR was associated with some, but not all, of the other domains of end-of-life care that were examined; responses to questions about these other aspects of end-of-life care were not always aligned with participants' CPR preference. Meaning Code status discussions with patients receiving dialysis should be integrated with broader conversations about their values, goals, and preferences for end-of-life care.This cross-sectional survey study describes the cardiopulmonary resuscitation preferences of patients receiving dialysis and how these preferences are associated with their responses to questions about other aspects of end-of-life care.Importance Whether the cardiopulmonary resuscitation (CPR) preferences of patients receiving dialysis align with their values and other aspects of end-of-life care is not known. Objective To describe the CPR preferences of patients receiving dialysis and how these preferences are associated with their responses to questions about other aspects of end-of-life care. Design, Setting, and Participants Cross-sectional survey study of a consecutive sample of patients receiving dialysis at 31 nonprofit dialysis facilities in 2 US metropolitan areas (Seattle, Washington, and Nashville, Tennessee) between April 22, 2015, and October 2, 2018. Analyses for this article were conducted between December 2018 and April 2020. Exposures Participants were asked to respond to the question "If you had to decide right now, would you want CPR if your heart were to stop beating?" Those who indicated they would probably or definitely want CPR were categorized as preferring CPR. Main Outcomes and Measures This study examined the association between preference for CPR and other treatment preferences, engagement in advance care planning, values, desired place of death, expectations about prognosis, symptoms, and palliative care needs. Results Of the 1434 individuals invited to complete the survey, 1009 agreed to participate, and 876 were included in the analytic cohort (61.1%). The final cohort had a mean (SD) age of 62.6 (14.0) years; 492 (56.2%) were men, and 528 (60.3%) were White individuals. Among 738 of 876 participants (84.2%) who indicated that they would definitely or probably want CPR (CPR group), 555 (75.2%) wanted mechanical ventilation vs 13 of 138 (9.4%) of those who did not want CPR (do not resuscitate [DNR] group) (P < .001). A total of 249 of 738 participants (33.7%) in the CPR group vs 84 of 138 (60.9%) in the DNR group had documented treatment preferences (P < .001). In terms of values about future care, 171 participants (23.2%) in the CPR group vs 5 of 138 (3.6%) in the DNR group valued life prolongation (P < .001); 320 in the CPR group (43.4%) vs 109 of 138 in the DNR group (79.0%) valued comfort (P < .001); and 247 participants (33.5%) in the CPR group vs 24 of 138 (17.4%) in the DNR group were unsure about their wishes for future care (P < .001). In the CPR group, 207 (28.0%) had thought about stopping dialysis vs 62 of 138 (44.9%) in the DNR group (P < .001), and 181 (24.5%) vs 58 of 138 (42.0%) had discussed stopping dialysis (P = .001). No statistically significant associations were observed between CPR preference and documentation of a surrogate decision maker, thoughts or discussion of hospice, preferred place of death, expectations about prognosis, reported symptoms, or palliative care needs. Conclusions and Relevance The CPR preferences of patients receiving dialysis were associated with some, but not all, other aspects of end-of-life care. How participants responded to questions about these other aspects of end-of-life care were not always aligned with their CPR preference. More work is needed to integrate discussions about code status with bigger picture conversations about patients' values, goals, and preferences for end-of-life care.