Heyland Daren K, Tranmer Joan, O'Callaghan C J, Gafni Amiram
Department of Medicine, Queen's University, Kingston, Ontario, Canada.
J Crit Care. 2003 Mar;18(1):3-10. doi: 10.1053/jcrc.2003.YJCRC2.
The objective of this study was to further our understanding of the decision-making process near the end of life. Specifically, we ascertained the seriously ill patients' preferred role in the decision-making process, what factors were associated with this role, and how this stated preference related to physicians' perception of preferred role.
Prospective cohort study of hospitalized patients with end-stage congestive heart disease, chronic pulmonary disease, cirrhosis, or metastatic cancer. Eligible patients were interviewed to ascertain their personal views on end-of-life decision making, desired role, and level of symptoms experienced.
A total of 135 patients were enrolled in this study. The majority of patients (103, 76%) had thought about end-of-life issues although only 48 (36%) had discussed them with their doctor in the hospital. With respect to preferred role in decision making, in the scenario of a competent patient, 14 (10%) preferred to leave all decisions to the doctor, 12 (9%) preferred that the doctor make the final decision after considering their opinion, 43 (32%) preferred that the doctor shared responsibility with them to make the decision, 32 (24%) patients preferred to make the final decision after considering the doctor's opinion, 21 (16%) preferred to make the treatment decision alone, and 13 (10%) did not answer. Physicians were not able to accurately predict patient's preferred role nor could the variability in patient choice be accounted for by demographic or symptom covariates.
Seriously ill hospitalized patients desire to discuss end-of-life issues with their physicians but their preferred role in decision making is variable and difficult to predict.
本研究的目的是加深我们对临终决策过程的理解。具体而言，我们确定了重症患者在决策过程中偏好的角色、与该角色相关的因素，以及这种明确表达的偏好与医生对偏好角色的认知之间的关系。
对患有终末期充血性心力衰竭、慢性肺病、肝硬化或转移性癌症的住院患者进行前瞻性队列研究。对符合条件的患者进行访谈，以确定他们对临终决策、期望角色和所经历症状水平的个人看法。
本研究共纳入135例患者。大多数患者（103例，76%）曾思考过临终问题，尽管只有48例（36%）在医院与医生讨论过这些问题。关于决策中的偏好角色，在有行为能力的患者的情况下，14例（10%）倾向于将所有决策留给医生，12例（9%）倾向于医生在考虑他们的意见后做出最终决策，43例（32%）倾向于医生与他们共同承担决策责任，32例（24%）患者倾向于在考虑医生的意见后做出最终决策，21例（16%）倾向于独自做出治疗决策，13例（10%）未作答。医生无法准确预测患者偏好的角色，患者选择的变异性也无法通过人口统计学或症状协变量来解释。
重症住院患者希望与医生讨论临终问题，但他们在决策中偏好的角色是可变的，且难以预测。
