Dying well after discontinuing the life-support treatment of dialysis
Dying well after discontinuing the life-support treatment of dialysis
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DOI：
10.1001/archinte.160.16.2513
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发表时间：
2000-09-11
影响因子：
--
通讯作者：
Kjellstrand, CM
中科院分区：
文献类型：
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作者：
Cohen, LM;Germain, MJ;Kjellstrand, CM
背景：在越来越多的病例中，停止延长生命的治疗先于死亡，但很少有人关注死亡的质量。研究对象和方法：前瞻性队列观察性研究，包括美国的6家透析诊所和加拿大的2家诊所，131名接受维持性透析的成人患者在停止治疗后死亡。60%的患者(n=79)接受了患者(n=23)和/或家属(n=76)的面谈和与照顾者的随访。结果：调查对象为59%的女性，年龄为70.0±1.2岁，透析时间为34.0±2.8个月，死亡时间为8.2±0.7天。(数据以平均值+/-SE表示。)在完成方案的受试者中，38%的人被判断死亡情况非常好，47%的人死亡情况良好，15%的人死亡情况不佳。在生命的最后一天，81%的样本没有遭受痛苦，尽管42%的人有一些疼痛，另外5%的人有严重的疼痛。根据死亡质量测量的心理社会领域，死于家中或接受临终关怀的患者的死亡情况好于死于医院或养老院的患者。结论：大多数患者在停止透析后死亡情况良好或非常好。死亡地点和医生态度对停止生命支持决策的影响值得更多的研究关注。临终工具的质量可以用来建立提供临终关怀的基准。
Background: Cessation of life-prolonging treatments precedes death in an increasing number of cases, but little attention has been accorded to the quality of dying.Objective? To examine the quality of dying following dialysis termination.Patients and Methods: A prospective cohort, observational study involved 6 dialysis clinics in the United States and 2 clinics in Canada, and 131 adult patients receiving maintenance dialysis who died after treatment cessation. Sixty percent (n=79) underwent patient (n=23) and/or family (n=76) interviews and follow-up with caretakers. A quality of dying tool quantified duration; pain and suffering, and psychosocial factors.Results: The sample was 59% female, the age was 70.0+/-1.2 years old, the duration of dialysis was 34.0+/-2.8 months, and death occurred 8.2+/-0.7 days after the last dialysis treatment. (Data are given as mean+/-SE.) Thirty-eight percent of the subjects who completed the protocol were judged to have had very good deaths, 47% had good deaths, and 15% had bad deaths. During the last day of life, 81% of the sample did not suffer, although 42% had some pain and an additional 5% had severe pain. According to the psychosocial domain of the quality of dying measure, patients who died at home or with hospice care had better deaths than those who died in a hospital or nursing home.Conclusions: Most deaths following withdrawal of dialysis were good or very good. The influence of site of death and physician attitudes about decisions to stop life support deserves more research attention. Quality of dying tools can be used to establish benchmarks for the provision of terminal care.