Failure of advance care planning to elicit patients' preferences for withdrawal from dialysis
Failure of advance care planning to elicit patients' preferences for withdrawal from dialysis
复制标题
DOI：
10.1016/s0272-6386(99)70220-9
复制
发表时间：
1999-04-01
影响因子：
13.2
通讯作者：
Moss, AH
中科院分区：
文献类型：
--
作者：
Holley, JL;Hines, SC;Moss, AH
虽然退出透析在透析患者中相对常见，但在预先护理计划中，患者对退出透析的考虑却知之甚少。我们研究了400名血液透析患者的分层随机样本，来自两个地理区域（worgantown 75英里内的所有6个透析单位，WV, Rochester， NY的所有9个透析单位），通过回顾对预先护理计划问题的问卷调查的回答。访谈由训练有素的采访者在常规血液透析治疗期间进行。51%的患者完成了预先指示（29%有生前遗嘱和医疗代理，22%有生前遗嘱或代理）。完成预先指示的患者更有可能通知决策者他们的角色（91%有生前遗嘱和医疗代理，81%有生前遗嘱或代理vs 55%没有预先指示，P < 0.01），大多数患者没有讨论永久性昏迷时具体干预的意愿：41%讨论过机械通气；35%，管饲；25%，心肺复苏；只有18%的人讨论过停止透析。完成生前遗嘱和代理人的患者最有可能讨论临终关怀，但停止透析是最不常讨论的干预措施，即使在这个患者群体中也是如此。69%的人讨论过机械通气；55%为管饲；43%，心肺复苏；只有31%的人讨论过停止透析（P < 0.001）。虽然退出透析是相对常见的，但很少在透析患者的预先护理计划中讨论，透析单位的工作人员和肾病学家应该与慢性透析患者一起解决涉及退出透析的问题。(C) 1999年由国家肾脏基金会，Inc。
Although withdrawal from dialysis is relatively common among dialysis patients, little is known about the patients' consideration of withdrawal during advance care planning. We studied a stratified random sample of 400 hemodialysis patients in two geographic areas (all six dialysis units within 75 miles of Morgantown, WV, and all nine dialysis units in Rochester, NY) by reviewing responses to a questionnaire addressing issues of advance care planning. Interviews were performed by trained interviewers during a routine hemodialysis treatment. Fifty-one percent of the patients had completed an advance directive (29% had a living will and a health care proxy, 22% had a living will or proxy). Patients who had completed advance directives were more likely to have notified their decision makers of their roles (91% with a living will and health care proxy, 81% with a living will or proxy v 55% who had no advance directive; P < 0.01), Most patients had not discussed their wishes for specific interventions in the event of permanent coma: 41% had discussed mechanical ventilation; 35%, tube feedings; 25%, cardiopulmonary resuscitation; and only 18% had discussed stopping dialysis. Patients who had completed a living will and proxy were most likely to have discussed end-of-life care, but stopping dialysis was the least often discussed intervention, even in this patient subset. Sixty-nine percent had discussed mechanical ventilation; 55%, tube feedings; 43%, cardiopulmonary resuscitation; and only 31% had discussed stopping dialysis (all P < 0.001). Although withdrawal from dialysis is relatively common, it is rarely discussed in advance care planning by dialysis patients, Dialysis unit staff and nephrologists should address issues involving withdrawal from dialysis with their chronic dialysjs patients. (C) 1999 by the National Kidney Foundation, Inc.