Rabow M W, Hardie G E, Fair J M, McPhee S J
Division of General Internal Medicine, University of California, San Francisco 94115, USA.
JAMA. 2000 Feb 9;283(6):771-8. doi: 10.1001/jama.283.6.771.
Prior reviews of small numbers of medical textbooks suggest that end-of-life care is not well covered in textbooks. No broad study of end-of-life care content analysis has been performed on textbooks across a wide range of medical, pediatric, psychiatric, and surgical specialties.
To determine the quantity and rate the adequacy of information on end-of-life care in textbooks from multiple medical disciplines. DESIGN AND SOURCES: A 1998 review of 50 top-selling textbooks from multiple specialties (cardiology, emergency medicine, family and primary care medicine, geriatrics, infectious disease and acquired immunodeficiency syndrome [AIDS], internal medicine, neurology, oncology and hematology, pediatrics, psychiatry, pulmonary medicine, and surgery) for the presence and adequacy of content in 13 end-of-life care domains.
Chapters on diseases commonly causing death and those devoted to end-of-life care were identified, read, rated, and compared by textbook specialty, chapter, and domain for the presence of helpful information in the 13 domains. Content for each domain was rated as absent, minimally present, or helpful. Textbook indexes were analyzed for the number of pages relevant to end-of-life care.
Overall, helpful information was provided in 24.1% (range, 8.7%-44.2%) of the expected end-of-life content domains; in 19.1% (range, 6.2%-38.5%), expected content received minimal attention; and in 56.9% (range, 23.1 %-77.9%), expected content was absent. As a group, the textbooks with the highest percentages of absent content were in surgery (71.8%), infectious diseases and AIDS (70%), and oncology and hematology (61.9%). Textbooks with the highest percentage of helpful end-of-life care content were in family medicine (34.4%), geriatrics (34.4%), and psychiatry (29.6%). In internal medicine textbooks, the content domains with the greatest amount of helpful information were epidemiology and natural history. Content domains covered least well were social, spiritual, ethical, and family issues, as well as physician after-death responsibilities. On average, textbook indexes cited 2% of their total pages as pertinent to end-of-life care.
Top-selling textbooks generally offered little helpful information on caring for patients at the end of life. Most disease-oriented chapters had no or minimal end-of-life care content. Specialty textbooks with information about particular diseases often did not contain helpful information on caring for patients dying from those diseases.
此前对少量医学教科书的综述表明，教科书对临终关怀的涵盖并不充分。尚未针对广泛的医学、儿科、精神病学和外科学科的教科书进行过关于临终关怀内容分析的全面研究。
确定多医学学科教科书临终关怀信息的数量并评估其充分性。
1998年对50本多专业畅销教科书（心脏病学、急诊医学、家庭与初级保健医学、老年医学、传染病与获得性免疫缺陷综合征[AIDS]、内科学、神经病学、肿瘤学与血液学、儿科学、精神病学、肺医学和外科学）进行综述，以确定13个临终关怀领域内容的有无及充分性。
识别、阅读、评分并比较各专业教科书、章节和领域中关于常见致死疾病及临终关怀章节，看其在13个领域中是否有有用信息。每个领域的内容被评为无、极少有或有帮助。分析教科书索引中与临终关怀相关的页数。
总体而言，在预期的临终关怀内容领域中，24.1%（范围8.7%-44.2%）提供了有用信息；19.1%（范围6.2%-38.5%）的预期内容受到极少关注；56.9%（范围23.1%-77.9%）的预期内容缺失。总体而言，内容缺失比例最高的教科书类别是外科学（71.8%）、传染病与AIDS（70%）以及肿瘤学与血液学（61.9%）。临终关怀内容有用比例最高的教科书类别是家庭医学（34.4%）、老年医学（34.4%）和精神病学（29.6%）。在内科学教科书中，有用信息最多的内容领域是流行病学和自然史。涵盖最不完善的内容领域是社会、精神、伦理和家庭问题以及医生死后的责任。平均而言，教科书索引中提及与临终关怀相关的页数占其总页数的2%。
畅销教科书通常在临终关怀患者方面提供的有用信息很少。大多数以疾病为导向的章节没有或极少有临终关怀内容。关于特定疾病的专业教科书通常不包含关于照顾因这些疾病而死亡患者的有用信息。
