A retrospective case series of suicide attempts leading to hospice admission.
A retrospective case series of suicide attempts leading to hospice admission.
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DOI：
10.1017/s1478951513000096
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发表时间：
2013-06
影响因子：
2.2
通讯作者：
Irwin SA
中科院分区：
文献类型：
--
作者：
Fairman N;Irwin SA
本研究旨在系统地识别和描述一组在临终关怀中接受生命限制性损伤治疗的患者，这些患者在自杀企图中持续存在，但不会立即致命。我们开发了一个案例系列的所有完成自杀在一个大型的，以社区为基础的临终关怀，从2004年到2010年。临床文件和县法医报告被用来确定那些死亡，导致自杀企图之前，临终关怀入院。案件的特点是在基本的人口统计变量，从医院护理到临终关怀，损伤和医疗并发症的机制，精神疾病的存在，和家庭参与决策的过渡事件的时间顺序。在研究期间总共20，887例临终关怀死亡中，8例死亡是由于临终关怀入院前的不完全自杀企图造成的。受试者几乎都是男性（6/8），平均年龄为46岁，比一般临终关怀人群年轻得多。药物过量是最常见的自杀方式（5/8），不可逆性缺氧性脑损伤是主要的内科并发症。大多数受试者（6/8）有严重精神疾病的证据。大多数病例因疏远的家庭关系而复杂化;然而，几乎所有患者的家庭成员都参与了临终决策。虽然导致临终关怀的自杀未遂似乎是一个相对罕见的事件，但该人群中的患者在几个方面似乎是独特的。进一步的研究可能有助于更好地描述这一群体，并为临终关怀机构和临床医生照顾这一独特的人群做好准备。
This investigation sought to systematically identify and characterize a cohort of patients treated in hospice for life-limiting injuries sustained in a suicide attempt that was not immediately lethal. We developed a case series of all completed suicides in a large, community-based hospice, from 2004 through 2010. Clinical documentation and county medical examiner reports were used to identify those deaths that resulted from a suicide attempt made prior to hospice admission. Cases were characterized in terms of basic demographic variables, the temporal sequence of events in the transition from hospital care to hospice, the mechanism of injury and medical complications, the presence of mental illness, and family involvement in decision making. Out of a total of 20,887 hospice deaths during the study period, 8 deaths resulted from an incomplete suicide attempt made prior to hospice admission. Subjects were nearly all male (6/8), and 46 years old on average; substantially younger than the general hospice population. Drug overdose was the most common method of suicide (5/8), and irreversible anoxic brain injury was the main medical complication. The majority of subjects (6/8) had evidence of serious mental illness. Most cases were complicated by estranged family relationships; however, family members were involved in end-of-life decision making for nearly all patients. Whereas a failed suicide attempt leading to hospice appears to be a relatively rare event, patients in this population appear unique in several regards. Further study may serve to better characterize this group and prepare hospice agencies and clinicians for caring for this unique population.