Physicians' and spouses' predictions of elderly patients' resuscitation preferences.
Physicians' and spouses' predictions of elderly patients' resuscitation preferences.
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医生和配偶对老年患者复苏偏好的预测。
DOI：
10.1093/geronj/43.5.m115
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发表时间：
1988
期刊：
影响因子：
--
通讯作者：
Cain,KC
中科院分区：
文献类型：
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作者：
Uhlmann,RF;Pearlman,RA;Cain,KC
“替代判断”，即替代决策者近似病人的意愿，已被推荐为精神上无行为能力的病人的决策。为了测试潜在的替代决策者对患者偏好的理解，我们研究了初级保健医生（n = 105）和配偶（n = 90）对老年门诊患者（n = 258）对心肺复苏（CPR）和CPR+呼吸机（CPR + V）偏好的预测，假设三种基线健康状态：当前健康，中风和慢性肺病。虽然超过四分之三的受访医生和配偶认为他们对患者偏好的预测是准确的，但医生和配偶的预测准确性并没有超过预期，因为6个决定中有5个和6个决定中有3个。在中风和慢性肺部疾病的情况下，医生显著低估了患者对复苏的偏好（p < .01），而在当前的健康/CPR决策中，医生显著高估了他们（p < .05）。在所有的决定中，配偶高估了患者对复苏的偏好，在三个CPR + V决定中也是如此（p <0.05）。这些结果表明，医生和配偶往往不了解老年门诊病人的复苏偏好。在这种情况下，他们不太可能提供准确的替代判断。
“Substitutedjudgment,” in which surrogate decisionmakers approximate patients' wishes, has been recommended for decision making for mentally incapacitated patients. To test understanding of patients' preferences by potential surrogate decisionmakers, we studied primary care physicians' (n = 105) and spouses' (n = 90) predictions of elderly outpatients' (n = 258) preferences for cardiopulmonary resuscitation (CPR) and cpr plus ventilator (CPR + V), assuming three baseline health states: current health, stroke, and chronic lung disease. Although more than threequarters of physicians and spouses surveyed believed their predictions of patients' preferences were accurate, the accuracy of physicians' and spouses' predictions did not exceed that expected due to chance alone in 5 of 6, and 3 of 6 decisions, respectively. Physicians significantly underestimated patients' preferences for resuscitation in the stroke and chronic lung disease scenarios (p < .01), and significantly overestimated them in the current health/CPR decision (p < .05). Spouses overestimated patients' preferences for resuscitation in all decisions, significantly so in the three CPR + V decisions (p < .05). These results suggest physicians and spouses often do not understand elderly outpatients' resuscitation preferences. Under these circumstances they are unlikely to provide accurate substituted judgments.