Life-sustaining treatment preferences of hemodialysis patients: implications for advance directives.
Life-sustaining treatment preferences of hemodialysis patients: implications for advance directives.
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血液透析患者的生命维持治疗偏好：对预先指示的影响。
DOI：
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发表时间：
1995
影响因子：
13.6
通讯作者：
D. Mendelssohn
中科院分区：
文献类型：
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作者：
P. Singer;E. Thiel;C. Naylor;R. Richardson;H. Llewellyn;M. Goldstein;C. Saiphoo;P. Uldall;D. Kim;D. Mendelssohn
本研究的目的是描述透析患者的生命维持治疗偏好，并比较两种通用和疾病特异性预先指令（AD）的可接受性。在532例可能合格的血液透析患者中，95例（17.9%）参与了研究。这些患者在一项随机交叉试验中完成了两项通用（生物伦理中心生活意愿和医疗指令）和一项疾病特异性（透析生活意愿）AD。治疗偏好是通过使用中心生物伦理学生活意愿。AD的可接受性通过使用每个AD的13项预先指示可接受性问卷（ADAQ）和预先指示选择问卷（ADCQ）来测量，以引出参与者的首选AD。25%的参与者希望在严重中风的情况下继续透析，19%的参与者希望在严重痴呆的情况下继续透析，14%的参与者希望在永久昏迷的情况下继续透析。在不同的治疗中，希望接受治疗的参与者比例为：当前健康（86%），轻度中风（84%），中度中风（60%），重度中风（21%），轻度痴呆（78%），中度痴呆（51%），重度痴呆（14%），晚期疾病（41%）和永久昏迷（10%）。在不同健康状况下，想要接受各种治疗的参与者比例为：透析（58%），抗生素（53%），输血（53%），手术（48%），心肺复苏（48%），呼吸机（47%）和管饲（41%）。平均ADAQ评分为：透析生存意愿，71%;生物伦理中心生存意愿，70%;医疗指令，60%（F = 8.27，P < 0.001（重复测量方差分析）;透析生存意愿和生物伦理中心生存意愿得分显著高于医疗指令）。表示他们将选择完成每个AD的参与者比例为：透析生活意愿，28%;生物伦理中心生活意愿，38%;医疗指令，31%;不确定，3%（卡方2 = 1.465，df = 2，P = 0.48）。总之，25%或更少的血液透析患者希望在三种特定的健康状态下继续透析：严重中风，严重痴呆和永久昏迷。健康状况和疾病严重程度，远远超过治疗描述，影响偏好。应向透析患者提供通用AD，某些通用AD比其他更容易接受。只有少数透析患者会填写任何AD，但填写书面AD表格只是预先护理计划过程中的一个要素。
The purpose of this study was to describe the life-sustaining treatment preferences of dialysis patients and to compare the acceptability of two generic and a disease-specific advance directive (AD). Of 532 potentially eligible hemodialysis patients, 95 (17.9%) participated in the study. These patients completed two generic (the Centre for Bioethics Living Will and the Medical Directive) and one disease-specific (the Dialysis Living Will) AD in a randomized cross-over trial. Treatment preferences were measured by using the Centre for Bioethics Living Will. Acceptability of the AD was measured by using a 13-item advance directive acceptability questionnaire (ADAQ) for each AD, and the advance directive choice questionnaire (ADCQ) to elicit participants' preferred AD. Twenty-five percent of the participants wanted to continue dialysis in case of severe stroke, 19% in severe dementia, and 14% in permanent coma. Averaged across treatments, proportions of participants wanting treatment in various health states were: current health (86%), mild stroke (84%), moderate stroke (60%), severe stroke (21%), mild dementia (78%), moderate dementia (51%), severe dementia (14%), terminal illness (41%), and permanent coma (10%). Averaged across health states, proportions of participants wanting various types of treatment were: dialysis (58%), antibiotics (53%), transfusion (53%), surgery (48%), cardiopulmonary resuscitation (48%), respirator (47%), and tube feeding (41%). Mean ADAQ scores were: Dialysis Living Will, 71%; Centre for Bioethics Living Will, 70%; and Medical Directive, 60% (F = 8.27, P < 0.001 (repeat measures analysis of variance); the Dialysis Living Will and Centre for Bioethics Living Will scored significantly higher than the Medical Directive). The proportion of participants who said they would choose to complete each AD was: Dialysis Living Will, 28%; Centre for Bioethics Living Will, 38%; Medical Directive, 31%; and unsure, 3% (chi 2 = 1.465, df = 2, P = 0.48). In conclusion, twenty-five percent or less of hemodialysis patients want to continue dialysis in three specific health states: severe stroke, severe dementia, and permanent coma. Health states and illness severity, far more than treatment descriptions, influence preferences. Dialysis patients should be offered a generic AD, and some generic AD are more acceptable than others. Only a minority of dialysis patients will complete any AD, but the completion of written AD forms is only one element in the process of advance care planning.