Richter J, Eisemann M R, Zgonnikova E
Clinic of Psychiatry and Psychotherapy at Rostock University, Rostock, Germany.
MedGenMed. 2001 Jul 12;3(4):4.
To explore the relationships between personality characteristics, underlying attitudes, and treatment decisions for severely ill elderly patients in a sample of Russian doctors.
Survey.
Group sessions during meetings or individual presentations of questionnaire.
A convenience sample of 231 physicians from the Archangelsk region in northern Russia who frequently encounter treatment situations with incompetent elderly patients.
Temperament and Character Inventory (Cloninger et al, 1994) for assessing personality dimensions. The questionnaire on decision-making is based on the original developed by Molloy and coworkers from McMaster University in Canada. In a case-vignette, the condition of an 82-year-old man with acute gastrointestinal bleeding is described comprehensively in combination with 3 different levels of information about the patient wishes (no information, DNR order, advance directive). Questions about importance of legal concerns, patient and family wishes, hospital costs, patient's age and level of dementia, and physician's religion for the doctor's decision-making are added.
No significant relationship was found between chosen treatment options and personality traits in any of the 3 situations. However, personality characteristics such as self-directedness, cooperativeness, and self-transcendence, in particular, show significant relationships with attitudes underlying these decisions.
Physicians should be trained to improve their cooperative abilities in the treatment of severely ill elderly patients to be better prepared for their decision-making and coping concerning end-of-life decisions and the use of do-not-resuscitate orders and advance directives. Ethical values in clinical practice, especially patient autonomy, should be addressed during the early stage of the medical curriculum.
在一组俄罗斯医生样本中，探究人格特征、潜在态度与重症老年患者治疗决策之间的关系。
调查。
会议期间的小组讨论或问卷的个人展示。
来自俄罗斯北部阿尔汉格尔斯克地区的231名医生的便利样本，他们经常遇到老年患者无行为能力的治疗情况。
使用气质和性格量表（Cloninger等人，1994年）评估人格维度。决策问卷基于加拿大麦克马斯特大学的莫洛伊及其同事最初编制的问卷。在一个病例 vignette 中，全面描述了一名82岁急性胃肠道出血男性的病情，并结合了3种关于患者意愿的不同信息水平（无信息、不要复苏医嘱、预立医疗指示）。增加了关于法律问题、患者及家属意愿、医院费用、患者年龄和痴呆程度以及医生宗教信仰对医生决策重要性的问题。
在3种情况中的任何一种情况下，所选治疗方案与人格特质之间均未发现显著关系。然而，诸如自我导向、合作性和自我超越等人格特征尤其与这些决策背后的态度存在显著关系。
应培训医生提高其在治疗重症老年患者方面的合作能力，以便更好地为临终决策、使用不要复苏医嘱和预立医疗指示做好决策和应对准备。医学课程早期阶段应涉及临床实践中的伦理价值观，尤其是患者自主权。
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