Patient preferences for communication with physicians about end-of-life decisions
Patient preferences for communication with physicians about end-of-life decisions
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DOI：
10.7326/0003-4819-127-1-199707010-00001
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发表时间：
1997-07-01
影响因子：
39.2
通讯作者：
Phillips, RS
中科院分区：
文献类型：
--
作者：
Hofmann, JC;Wenger, NS;Phillips, RS
背景：医生经常不知道病人对临终关怀的偏好。识别和探索患者与医生之间关于临终问题的沟通障碍可能有助于指导医生和患者进行更有效的讨论。目的：研究患者沟通的相关性和相关结果以及患者与医生就心肺复苏和延长机械通气进行沟通的偏好。设计：前瞻性队列研究。设置：五家三级护理医院。患者：2162名合格患者中有1832名（85%）完成了访谈。测量：调查患者特征和对临终关怀的偏好;对预后、决策和生活质量的看法;以及患者与医生就临终决策进行沟通的偏好。结果：不到四分之一（23%）的重症患者曾与医生讨论过心肺复苏的偏好。在没有讨论他们对复苏的偏好的患者中，58%的人对这样做不感兴趣。在没有讨论过或不想讨论他们的偏好的患者中，25%的人不想复苏。在多变量分析中，与不想讨论心肺复苏偏好相关的独立患者因素包括黑人以外的种族（调整后比值比[OR]I 1.48 [95% CI，1.10 - 1.99），无预先指示（OR，1.35 [CI，1.04 - 1.76]），估计预后良好（OR，1.72 [Cl，1.32至2.59]），报告生活质量为一般至极好（OR，1.36 [CI，1.05至1.76]），不希望积极参与医疗决策（OR，1.33 [CI，1.07至1.65]）。与想要讨论复苏偏好但没有这样做的独立相关因素包括黑人（OR，1.53 [CI，1.11至2.11]）和年轻人（OR，1.14每10年间隔年轻[CI，1.04至1.25]）。大多数没有讨论过临终关怀偏好的患者不想这样做。对于不想讨论其偏好的患者，以及未满足此类讨论需求的患者，未能讨论心肺复苏和机械通气的偏好可能会导致不必要的干预。
Background: Physicians are frequently unaware of patient preferences for end-of-life care. Identifying and exploring barriers to patient-physician communication about end-of-life issues may help guide physicians and their patients toward more effective discussions.Objective: To examine correlates and associated outcomes of patient communication and patient preferences for communication with physicians about cardiopulmonary resuscitation and prolonged mechanical ventilation.Design: Prospective cohort study.Setting: Five tertiary care hospitals.Patients: 1832 (85%) of 2162 eligible patients completed interviews.Measurements: Surveys of patient characteristics and preferences for end-of-life care; perceptions of prognosis, decision making, and quality of life; and patient preferences for communication with physicians about end-of-life decisions.Results: Fewer than one fourth (23%) of seriously ill patients had discussed preferences for cardiopulmonary resuscitation with their physicians. Of patients who had not discussed their preferences for resuscitation, 58% were not interested in doing so. Of patients who had not discussed and did not want to discuss their preferences, 25% did not want resuscitation. In multivariable analyses, patient factors independently associated with not wanting to discuss preferences for cardiopulmonary resuscitation included being of an ethnicity other than black (adjusted odds ratio [OR]I 1.48 [95% CI, 1.10 to 1.99), not having an advance directive (OR, 1.35 [CI, 1.04 to 1.76]), estimating an excellent prognosis (OR, 1.72 [Cl, 1.32 to 2.59]), reporting fair to excellent quality of life (OR, 1.36 [CI, 1.05 to 1.76]), and not desiring active involvement in medical decisions (OR, 1.33 [Ci, 1.07 to 1.65]). Factors independently associated with wanting to discuss preferences for resuscitation but not doing so included being black (OR, 1.53 [CI, 1.11 to 2.11]) and being younger (OR, 1.14 per 10-year interval younger [CI, 1.04 to 1.25]).Conclusions: Among seriously ill hospitalized adults, communication about preferences for cardiopulmonary resuscitation is uncommon. A majority of patients who have not discussed preferences for end-of-life care do not want to do so. For patients who do not want to discuss their preferences, as well as patients with an unmet need for such discussions, failure to discuss preferences for cardiopulmonary resuscitation and mechanical ventilation may result in unwanted interventions.