Physician Practices for Communicating With Patients With Cystic Fibrosis About the Use of Noninvasive and Invasive Mechanical Ventilation
Physician Practices for Communicating With Patients With Cystic Fibrosis About the Use of Noninvasive and Invasive Mechanical Ventilation
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DOI：
10.1378/chest.11-1323
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发表时间：
2012-04-01
期刊：
影响因子：
9.6
通讯作者：
Hanson, Laura C.
中科院分区：
文献类型：
--
作者：
Dellon, Elisabeth P.;Sawicki, Gregory S.;Hanson, Laura C.
背景资料：许多晚期囊性纤维化（CF）肺病患者在很少或没有与医生沟通后接受强化治疗，如无创和有创机械通气治疗呼吸衰竭。Methods：使用调查和随访访谈，两个主要CF护理中心的医生报告了他们与CF患者讨论强化治疗偏好以及沟通障碍和促进因素的做法。调查由34名合格的CF医生中的30名（88%）和26名（76%）完成，他们为儿童（60%），成人（23%）或两者兼而有之（17%）提供护理。答复者描述了各种不同的讨论时间和内容。他们确定了患者/家庭因素，如否认疾病严重程度，对治疗结果的乐观期望，患病患者无法参与讨论，以及家庭对治疗的分歧是讨论的主要障碍。他们还承认医生的因素，包括担心带走希望和不确定何时解决治疗偏好。患者/家庭因素也是最常见的促进因素，特别是疾病严重程度和对强化治疗的询问。他们建议：（1）制定沟通标准，（2）为医生提供沟通培训，（3）为患者和家庭创建决策支持工具，（4）使用多学科CF护理团队，以促进communication.Conclusions：CF医生描述了许多患者/家庭因素的障碍，沟通有关呼吸衰竭的强化治疗。他们建议改变医生和组织因素，以改善实践和促进有效的沟通。临床培训、团队角色和决策支持方面的创新可能会促使实践标准发生变化。胸部2012; 141（4）：1010-1017
Background: Many patients with advanced cystic fibrosis (CF) lung disease receive intensive treatments such as noninvasive and invasive mechanical ventilation for respiratory failure after little or no communication with physicians.Methods: Using surveys and follow-up interviews, physicians at two major CF care centers reported their practices for discussing intensive treatment preferences with patients with CF and about barriers and facilitators to communication.Results: Surveys were completed by 30 (88%) and 26 (76%) of 34 eligible CF physicians who provide care for children (60%), adults (23%), or both (17%). Respondents described variable timing and content of discussions. They identified patient/family factors such as denial of disease severity, optimistic expectations of treatment outcomes, inability of ill patients to participate in discussions, and family disagreements about treatments as primary barriers to discussions. They also acknowledged physician factors, including concern for taking away hope and uncertainty about when to address treatment preferences. Patient/family factors were also the most common facilitators identified, particularly disease severity and inquiry about intensive treatments. They recommended: (1) developing standards for communication, (2) offering training in communication for physicians, (3) creating decision support tools for patients and families, and (4) using the multidisciplinary CF care team to facilitate communication.Conclusions: CF physicians describe numerous patient/family factors barriers to communicating about intensive treatments for respiratory failure. They recommend changing physician and organizational factors to improve practice and promote effective communication. Innovation in clinical training, team roles, and decision support may prompt changes in practice standards. CHEST 2012; 141(4):1010-1017