The effect of do-not-resuscitate orders on physician decision-making
The effect of do-not-resuscitate orders on physician decision-making
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DOI：
10.1046/j.1532-5415.2002.50620.x
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发表时间：
2002-12-01
影响因子：
6.3
通讯作者：
Morrison, RS
中科院分区：
文献类型：
--
作者：
Beach, MC;Morrison, RS
使用横断面邮寄调查探讨了不要复苏（DNR）命令对医生决定为接近生命终点的患者提供心肺复苏（CPR）以外的延长生命治疗的影响。每项调查提供了三种患者情景，然后是10种治疗决策。参与者是住院医师和主治医师，他们被随机分配调查，其中所有患者的情况包括或不包括DNR订单。收到了463名医生中241名（52%）的回复。医生同意或强烈同意在DNR命令存在与不存在时启动较少的干预措施（第一种情况下为4.2 vs 5.0（P= .008）;第二种情况下为6.5 vs 7.1（P= .004）;第三种情况下为5.7 vs 6.2（P= .037））。在所有三种情况下，DNR命令的患者被转移到重症监护室，插管或接受CPR的可能性显着降低。在某些情况下，DNR命令的存在与抽取血培养（91%vs98%，P = 0.038）、放置中心静脉导管（68%vs80%，P = 0.030）或输血（75%vs87%，P = 0.015）的意愿降低相关。DNR命令的存在可能会影响医生订购与CPR无关的各种治疗的意愿。DNR订单的患者可以选择放弃其他延长生命的治疗，但医生应该了解有关患者治疗目标的其他信息，以告知这些决定。
The effect of do‐not‐resuscitate (DNR) orders on physicians' decisions to provide life‐prolonging treatments other than cardiopulmonary resuscitation (CPR) for patients near the end of life was explored using a cross‐sectional mailed survey. Each survey presented three patient scenarios followed by 10 treatment decisions. Participants were residents and attending physicians who were randomly assigned surveys in which all patient scenarios included or did not include a DNR order.Response to three case scenarios when a DNR order was present or absent were measured. Response from 241 of 463 physicians (52%) was received. Physicians agreed or strongly agreed to initiate fewer interventions when a DNR order was present versus absent (4.2 vs 5.0 (P= .008) in the first scenario; 6.5 vs 7.1 (P= .004) in the second scenario; and 5.7 vs 6.2 (P= .037) in the third scenario). In all three scenarios, patients with DNR orders were significantly less likely to be transferred to an intensive care unit, to be intubated, or to receive CPR. In some scenarios, the presence of a DNR order was associated with a decreased willingness to draw blood cultures (91% vs 98%,P= .038), central line placement (68% vs 80%,P= .030), or blood transfusion (75% vs 87%,P= .015). The presence of a DNR order may affect physicians' willingness to order a variety of treatments not related to CPR. Patients with DNR orders may choose to forgo other life‐prolonging treatments, but physicians should elicit additional information about patients' treatment goals to inform these decisions.