Clinicians' Perceptions of Futile or Potentially Inappropriate Care and Associations with Avoidant Behaviors and Burnout
Clinicians' Perceptions of Futile or Potentially Inappropriate Care and Associations with Avoidant Behaviors and Burnout
复制标题
DOI：
10.1089/jpm.2018.0385
复制
发表时间：
2019-09-01
影响因子：
2.8
通讯作者：
Prigerson, Holly G.
中科院分区：
文献类型：
--
作者：
Chamberlin, Peter;Lambden, Jason;Prigerson, Holly G.
背景：对垂死住院患者的无效或潜在不适当护理（无效/PIC）会导致患者和临床医生的不良结局。在不断上升的临终医疗保健成本和增加医生倦怠的背景下，重要的是要了解徒劳/PIC的原因，它如何影响护理和与倦怠。目的：检查无效/PIC的原因，确定临床医生是否报告补偿或回避行为作为这种护理的结果，并评估这些行为是否与倦怠有关。设计：在线横断面问卷。地点/受试者：纽约市两家学术医院的临床医生。研究方法：受访者被问及他们观察或提供徒劳/PIC的频率，以及他们是否因此表现出补偿或回避行为。使用经验证的屏幕来评估倦怠。测量：描述性统计，比值比，线性回归。结果：349名受试者完成了调查。大多数临床医生（91.3%）认为他们在过去6个月内提供了或“可能”提供了无效/PIC。最常见的PIC原因（61.0%）是患者家属的坚持。目击和提供PIC与补偿行为和回避行为都有统计学显著性相关（p < 0.05），但与回避行为的相关性更强。提供PIC使回避患者亲人的可能性增加了2.40倍（1.82-3.19），回避患者的可能性增加了1.83倍（1.32-2.55），回避同事的可能性增加了2.56倍（1.57-4.20）（所有p < 0.001）。回避患者的亲人（β = 0.55，SE = 0.12，p < 0.001）、回避患者（β = 0.38，SE = 0.17; p = 0.03）和回避同事（β = 0.78，SE = 0.28; p = 0.01）与倦怠显著相关。结论：提供或观察到的无效/PIC与回避患者、家人和同事有关，这些行为与倦怠有关。
Background: Futile or potentially inappropriate care (futile/PIC) for dying inpatients leads to negative outcomes for patients and clinicians. In the setting of rising end-of-life health care costs and increasing physician burnout, it is important to understand the causes of futile/PIC, how it impacts on care and relates to burnout. Objectives: Examine causes of futile/PIC, determine whether clinicians report compensatory or avoidant behaviors as a result of such care and assess whether these behaviors are associated with burnout. Design: Online, cross-sectional questionnaire. Setting/Subjects: Clinicians at two academic hospitals in New York City. Methods: Respondents were asked the frequency with which they observed or provided futile/PIC and whether they demonstrated compensatory or avoidant behaviors as a result. A validated screen was used to assess burnout. Measurements: Descriptive statistics, odds ratios, linear regressions. Results: Surveys were completed by 349 subjects. A majority of clinicians (91.3%) felt they had provided or "possibly" provided futile/PIC in the past six months. The most frequent reason cited for PIC (61.0%) was the insistence of the patient's family. Both witnessing and providing PIC were statistically significantly (p < 0.05) associated with compensatory and avoidant behaviors, but more strongly associated with avoidant behaviors. Provision of PIC increased the likelihood of avoiding the patient's loved ones by a factor of 2.40 (1.82-3.19), avoiding the patient by a factor of 1.83 (1.32-2.55), and avoiding colleagues by a factor of 2.56 (1.57-4.20) (all p < 0.001). Avoiding the patient's loved ones (beta = 0.55, SE = 0.12, p < 0.001), avoiding the patient (beta = 0.38, SE = 0.17; p = 0.03), and avoiding colleagues (beta = 0.78, SE = 0.28; p = 0.01) were significantly associated with burnout. Conclusions: Futile/PIC, provided or observed, is associated with avoidance of patients, families, and colleagues and those behaviors are associated with burnout.