Key Physician Behaviors that Predict Prudent, Preference Concordant Decisions at the End of Life.
Key Physician Behaviors that Predict Prudent, Preference Concordant Decisions at the End of Life.
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DOI：
10.1080/23294515.2020.1865476
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发表时间：
2021-10
影响因子：
--
通讯作者：
Barnato A
中科院分区：
文献类型：
--
作者：
Morales A;Murphy A;Fanning JB;Gao S;Schultz K;Hall DE;Barnato A
这项研究介绍了一种研究谨慎在医生临终(EOL)决策中的作用的实证方法。在一项关于EOL决策的多中心研究中，对88名模拟患者的记录进行了混合方法分析。内科、急诊和重症监护医学的医生被要求评估失代偿期的终末期癌症患者。这些会面的记录被编码为演员、行动和内容，以捕捉亚里士多德谨慎的概念，然后进行定量和定性分析，以确定与偏好一致的治疗相关的行动。聚焦于描述医患互动特征的代码，医生重申患者偏好的代码与避免插管有关。多个代码与偏好一致性处理的次要措施相关。谨慎的行为可以通过经验来确定，而专注于谨慎的优点的研究可能为EOL护理的评估和培训提供一种新的途径。
This study introduces an empirical approach for studying the role of prudence in physician treatment of end-of-life (EOL) decision making. A mixed-methods analysis of transcripts from 88 simulated patient encounters in a multicenter study on EOL decision making. Physicians in internal medicine, emergency medicine, and critical care medicine were asked to evaluate a decompensating, end-stage cancer patient. Transcripts of the encounters were coded for actor, action, and content to capture the concept of Aristotelian prudence, and then quantitatively and qualitatively analyzed to identify actions associated with preference-concordant treatment. Focusing on codes that describe characteristics of physician-patient interaction, the code for physicians restating patient preferences was associated with avoiding intubation. Multiple codes were associated with secondary measures of preference-concordant treatment. Prudent actions can be identified empirically, and research focused on the virtue of prudence may provide a new avenue for assessment and training in EOL care.