Nephrologists' reported preparedness for end-of-life decision-making
Nephrologists' reported preparedness for end-of-life decision-making
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DOI：
10.2215/cjn.02040606
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发表时间：
2006-11-01
影响因子：
9.8
通讯作者：
Moss, Alvin H.
中科院分区：
文献类型：
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作者：
Davison, Sara N.;Jhangri, Gian S.;Moss, Alvin H.
肾病专家通常与 ESRD 患者及其家人一起参与临终决策。本研究的目的是确定肾脏病学家做出临终决定的感知准备情况，并确定与最高感知准备水平相关的因素。肾脏医师协会 (RPA) 和加拿大肾脏病学会的肾病专家成员受邀参加一项关于其临终决策实践的在线调查。 360 名受访者中，共有 39% 的人认为自己已经做好了做出临终决定的充分准备。年龄 > 46 岁、前一年有 6 名或更多患者退出透析，以及对 RPA/美国肾脏病学会 (ASN) 关于透析决策指南的了解与自我报告的准备程度最高独立相关。报告称准备充分的肾科医生更有可能对患有永久性和严重痴呆的患者进行限时透析试验并停止透析。与美国人相比，加拿大肾脏病学家报告说，他们在做出临终决定时同样做好了准备，停止透析的患者数量较多，转诊至临终关怀医院的人数较少，并且更有可能停止患有严重痴呆症的患者的透析。实践时间较长且了解 RPA/ASN 指南的肾病专家表示，他们在做出临终决策时准备得更加充分，并且更频繁地根据指南建议这样做。为了提高肾脏病学家对临终决策的舒适度，奖学金计划应教授 RPA/ASN 指南和立场声明中的建议。
Nephrologists commonly engage in end-of-life decision-making with patients with ESRD and their families. The purpose of this study was to determine the perceived preparedness of nephrologists to make end-of-life decisions and to determine factors that are associated with the highest level of perceived preparedness. The nephrologist members of the Renal Physicians Association (RPA) and the Canadian Society of Nephrology were invited to participate in an online survey of their end-of-life decision-making practices. A total of 39% of 360 respondents perceived themselves as very well prepared to make end-of-life decisions. Age >46 yr, six or more patients withdrawn from dialysis in the preceding year, and awareness of the RPA/ American Society of Nephrology (ASN) guideline on dialysis decision-making were independently associated with the highest level of self-reported preparedness. Nephrologists who reported being very well prepared were more likely to use time-limited trials of dialysis and stop dialysis of a patient with permanent and severe dementia. Compared with Americans, Canadian nephrologists reported being equally prepared to make end-of-life decisions, stopped dialysis of a higher number of patients, referred fewer to hospice, and were more likely to stop dialysis of a patient with severe dementia. Nephrologists who have been in practice longer and are knowledgeable of the RPA/ASN guideline report greater preparedness to make end-of-life decisions and report doing so more often in accordance with guideline recommendations. To improve nephrologists' comfort with end-of-life decision-making, fellowship programs should teach the recommendations in the RPA/ASN guideline and position statement.