Medical Futility and Treatment Effect in DNR Orders

DNR 命令中的医疗无效性和治疗效果

• 批准号: 6315033
• 负责人: Elizabeth Trice Loggers
• 金额: $ 3.24万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-09-30 至 2002-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6315033
• 关键词: clinical research; decision making; disease /disorder proneness /risk; health care policy; health science research analysis /evaluation; health services research tag; human mortality; human subject; human therapy evaluation; patient care management; quality of life; stroke

Determining when medical care is ineffective, either at producing a desired physiologic effect or a benefit for the patient, is of growing interest. This interest, in what has been called medical futility in the bioethics literature, is the product of rising concern regarding issues of quality of life, patient autonomy, the use of technology and the allocation of scarce medical resources. This research uses medical futility as the conceptual framework from which to investigate the role of risk of death and expected quality of life in the assignment of a do not resuscitate (DNR) order. In addition, it will determine whether the assignment of a DNR order results in an increased risk of death for those who receive them compared to those who do not. This secondary analysis of a well-developed data set on hospitalized, stroke sufferers will use a variant of the bivariate probit model and logistic regression to answer the following specific aim is: 1. To determine whether having a DNR order results in an excess risk of death (DNR treatment effect). 2. To understand how both quantitative futility, (i.e., the risk of death), after controlling for the treatment effect of having a DNR, and qualitative futility, or the expectation of poor quality of life, is related to the assignment of a DNR order.

确定医疗护理何时无效（无论是无法产生所需的生理效果还是对患者有益）越来越受到人们的关注。这种在生物伦理学文献中被称为医疗无效性的兴趣，是人们对生活质量、患者自主权、技术的使用和稀缺医疗资源的分配等问题日益关注的产物。本研究使用医疗无效作为概念框架，调查死亡风险和预期生活质量在不复苏 (DNR) 指令分配中的作用。此外，还将确定 DNR 令的分配是否会导致接受 DNR 令的人与未获得 DNR 令的人相比死亡风险增加。对住院中风患者的完善数据集进行二次分析，将使用双变量概率模型和逻辑回归的变体来回答以下具体目标： 1. 确定 DNR 指令是否会导致死亡风险过高（DNR 治疗效果）。 2. 了解在控制 DNR 的治疗效果后，定量无效（即死亡风险）和定性无效（或生活质量差的预期）如何与 DNR 订单的分配相关。