Documentation of discussions about prognosis with terminally ill patients
Documentation of discussions about prognosis with terminally ill patients
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DOI：
10.1016/s0002-9343(01)00798-7
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发表时间：
2001-08-15
影响因子：
5.9
通讯作者：
Horwitz, SM
中科院分区：
文献类型：
--
作者：
Bradley, EH;Hallemeier, AG;Horwitz, SM
目得：以前的研究表明，在生命的最后阶段与患者进行预后沟通的重要性，但这种沟通的普遍性，内容和后果尚未得到充分调查。本研究的目的是估计有关于预后的讨论记录的晚期住院患者的比例，描述这种讨论的性质和相关性，并评估关于预后的讨论记录和随后的预先护理计划之间的关联。从康涅狄格州随机选择的6家社区医院随机选择至少65岁的脑癌、胰腺癌、肝癌、胆囊癌或无法手术的肺癌住院患者（n = 232）。预后，先进的护理计划的努力，社会人口和临床因素的讨论的存在和内容进行了全面审查的医疗记录，使用一个标准化的abstraction form.Results：讨论预后记录在89（38%）例患者的医疗记录。在这些病例中，46例（52%）的医生和患者都出席了讨论。很少记录预期死亡的时间。有关于预后的讨论记录与关于维持生命治疗的讨论记录相关（调整后的比值比[OR]= 5.8; 95%置信区间[Cl]：2.8 - 12.0），并有不复苏顺序（调整后OR = 2.2; 95% CI：1.1至4.2）。在晚期癌症患者中，关于病历中记录的预后的讨论很少，范围也有限。在某些情况下，这种记录的讨论可能是重要的催化剂，为病人和家庭的喜好，关于治疗和未来的护理后续讨论。(C)2001年，Excerpta Medica，Inc.
PURPOSE: Previous studies have suggested the importance of communicating with patients about prognosis at the end of life, yet the prevalence, content, and consequences of such communication have not been fully investigated. The purposes of this study were to estimate the proportion of terminally ill inpatients with documented discussions about prognosis, describe the nature and correlates of such discussions, and assess the association between documented discussions about prognosis and subsequent advance care planning.SUBJECTS AND METHODS: Inpatients (n = 232) at least 65 years old who had brain, pancreas, liver, gall bladder, or inoperable lung cancer were randomly selected from six randomly chosen community hospitals in Connecticut. The presence and content of discussions about prognosis, advanced care planning efforts, and sociodemographic and clinical factors were ascertained by comprehensive review of medical records using a standardized abstraction form.RESULTS: Discussions about prognosis were documented in the medical records of 89 (38%) patients. Physicians and patients were both present during the discussion in 46 (52%) of these cases. Time until expected death was infrequently documented. Having a documented discussion about prognosis was associated with documented discussions of life-sustaining treatments (adjusted odds ratio [OR] = 5.8; 95% confidence interval [Cl]: 2.8 to 12.0) and having a do-not-resuscitate order (adjusted OR = 2.2; 95% CI: 1.1 to 4.2).CONCLUSIONS: Among terminally ill patients with cancer, discussions about prognosis as documented in medical charts are infrequent and limited in scope. In some cases, such documented discussions may be important catalysts for subsequent discussions of patient and family preferences regarding treatment and future care. (C) 2001 by Excerpta Medica, Inc.