Perceptions by family members of the dying experience of older and seriously ill patients
Perceptions by family members of the dying experience of older and seriously ill patients
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DOI：
10.7326/0003-4819-126-2-199701150-00001
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发表时间：
1997-01-15
影响因子：
39.2
通讯作者：
Connors, AF
中科院分区：
文献类型：
--
作者：
Lynn, J;Teno, JM;Connors, AF
背景资料：缓解临终者及其家属所面临的问题已经引起了大量的公众关注，但对死亡的经历知之甚少。目的：从替代决策者的角度描述死亡的经历，通常是亲密的家庭成员（89%）。设计：前瞻性队列研究。设置：五所教学医院。患者：患有九种严重疾病之一或80岁或以上死亡的人，并且代理决策者完成了有关死亡的采访。测量：审查了医疗记录并采访了代理决策者。结果：9105例重症患者中死亡4124例（46%）; 1176例老年患者中死亡408例（35%）。在3357人（73%）死亡后，对患者家属进行了采访。在1541名存活的患者中，46%的患者在以后的住院期间死亡，在生命的最后3天，55%的患者有意识。在这些患者中，疼痛、呼吸困难和疲劳是普遍的。10名患者中有4名大部分时间都有剧烈疼痛。10名患者中有8名严重疲劳。超过1/4的患者有中度烦躁。63%的患者难以忍受身体或情绪症状，总的来说，11%的患者进行了最后的复苏尝试。四分之一的患者使用呼吸机，十分之四的患者使用饲管。据报道，大多数患者（59%）更喜欢的治疗计划，专注于舒适，但据报道，护理相反的首选方法在10%的cases.Conclusions：大多数老年人和重病患者死亡的急性护理医院。疼痛和其他症状是常见的，并困扰着病人。家属认为，病人更喜欢舒适，但维持生命的治疗往往被使用。这些发现表明了改善临终病人护理的重要机会。
Background: Alleviating the problems faced by dying persons and their families has drawn substantial public attention, but little is known about the experience of dying.Objective: To characterize the experience of dying from the perspective of surrogate decision makers, usually close family members (89%).Design: Prospective cohort study.Setting: Five teaching hospitals.Patients: Persons who had one of nine serious medical conditions or were 80 years of age or older who died and for whom a surrogate decision maker completed an interview about the death.Measurements: Medical records were reviewed and surrogate decision makers were interviewed.Results: 4124 of 9105 seriously ill patients died (46%); 408 of 1176 elderly patients died (35%). The patients' family members were interviewed after 3357 persons (73%) had died. Of 1541 patients who survived the enrollment hospitalization, 46% died during a later hospitalization.In the last 3 days of life, 55% of patients were conscious. Among these patients, pain, dyspnea, and fatigue were prevalent. Four in 10 patients had severe pain most of the time. Severe fatigue affected almost 8 in 10 patients. More than 1 in 4 patients had moderate dysphoria. Sixty-three percent of patients had difficulty tolerating physical or emotional symptoms.Overall, 11% of patients had a final resuscitation attempt. A ventilator was used in one fourth of patients, and a feeding tube was used in four tenths of patients. Most patients (59%) were reported to prefer a treatment plan that focused on comfort, but care was reported to be contrary to the preferred approach in 10% of cases.Conclusions: Most elderly and seriously ill patients died in acute care hospitals. Pain and other symptoms were commonplace and troubling to patients. Family members believed that patients preferred comfort, but life-sustaining treatments were often used. These findings indicate important opportunities to improve the care of dying patients.