ACHIEVING CONSENSUS ON WITHDRAWING OR WITHHOLDING CARE FOR CRITICALLY ILL PATIENTS
ACHIEVING CONSENSUS ON WITHDRAWING OR WITHHOLDING CARE FOR CRITICALLY ILL PATIENTS
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DOI：
10.1007/bf02599446
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发表时间：
1992-09-01
影响因子：
5.7
通讯作者：
HYERS, TM
中科院分区：
文献类型：
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作者：
MILLER, DK;COE, RM;HYERS, TM
目的：探讨保留或停止生命维持的决策过程。设计:调查。环境：三级医疗中心的重症监护室。参与者：15例危重患者的医生及家属，7例患者也参与其中。测量方法：医生和家庭成员之间关于决定停止或停止治疗危重家庭成员的会议被录音。会议记录——分析1)过程：医生如何介绍做出决定的必要性，列出可能的结果，并最终做出决定；2)做了什么决定，3)结果；死亡，出院回家，或转到其他机构。结果：“病人的愿望”的概念是一个中心取向点协商共识关于保留或撤回治疗，即使病人不是一个参与者。医生倾向于提供直接和明确的介绍，在决策框架期间给予同等权重的选项，但在决策结束期间缩小选项以符合他们的判断。并非每个决定都与医生的判断一致。结论：对危重病人作出停止或撤销生命支持治疗的决定涉及复杂困难的过程。成功地管理生命延长、生活质量、患者自主和社会正义之间的紧张关系需要更好地理解这些过程。
Objective: To examine the decision-making process to withhold or stop life support.Design: Survey.Setting: Medical intensive care unit of a tertiary care center.Participants: Physicians and families of 15 critically ill patients, in seven cases patients also participated. Measurements: Meetings between physicians and family members concerning a decision to withhold or stop treatment of a critically ill family member were tape-recorded. Transcriptions of the meetings - analyzed for 1) process: bow the physician introduced the need for a decision, framed the likely outcomes of options, and closed on a decision; 2) what decision was made, and 3) the outcome; died, discharged home, or discharged to another institution.Results: The concept of "patient's wishes" was a central orientation point for the negotiation of consensus regarding withholding or withdrawing therapy even when the patient was not a participant. Physicians tended to provide a direct and unambiguous introduction, give equal weights to options during decision framing, but narrow the options during decision closure to correspond to their judgments. Not every decision was consistent with the physician's judgment.Conclusions: Decision making to withhold or withdraw Iife-support therapy from critically ill persons involves complex difficult processes. Successful management of the tension among life extension, quality of life, patient autonomy, and social justice requires better understanding of these processes.