Eidelman Leonid A, Jakobson Daniel J, Worner T M, Pizov Reuven, Geber Debora, Sprung Charles L
Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel.
J Crit Care. 2003 Mar;18(1):11-6. doi: 10.1053/jcrc.2003.YJCRC3.
The majority of patients dying in intensive care units (ICUs) do so after the forgoing of life-sustaining therapies (FLST). Communication between physicians, patients, and their families regarding the decision to FLST has not been evaluated in Israel.
All patients who had FLST in a general ICU were enrolled in the study. We evaluated whether physicians communicated and documented the FLST decisions with patients or the patients' families. We also assessed the effect of the physician's geographic place of training on communication behavior.
Over a period of 8.5 months, 385 patients were admitted to a general ICU in Israel. Fifty-seven patients died or had FLST. Twelve of these 57 were excluded from the study. Thus, 45 (79%) patients had FLST and were enrolled in the study. All patients were deemed medically incompetent to make FLST decisions. In 24 (53%) patients, FLST was discussed with the family before the decision to forgo therapy. Discussion occurred later with 6 other families, who were unavailable at the time the FLST decision was made. In 15 patients, there were no discussions with families. American-trained physicians discussed FLST with 22 of 29 families initially and 5 other families later (93%), whereas the Eastern European-trained physicians discussed FLST with only 3 of 16 (19%) families (P <.001). Documentation of FLST was present in 26 (90%) patients of American-trained physicians and 8 (50%) patients of Eastern European-trained physicians (P <.001).
FLST is common in an Israeli ICU. Patients are not medically competent to make FLST decisions. American-trained physicians discuss and document FLST more often than Eastern European-trained physicians.
大多数在重症监护病房（ICU）死亡的患者是在放弃维持生命治疗（FLST）后死亡的。在以色列，尚未对医生、患者及其家属之间关于FLST决定的沟通情况进行评估。
纳入在综合ICU接受FLST的所有患者。我们评估医生是否与患者或患者家属就FLST决定进行了沟通并记录。我们还评估了医生的地理培训地点对沟通行为的影响。
在8.5个月的时间里，385名患者入住以色列的一家综合ICU。57名患者死亡或接受了FLST。这57名患者中有12名被排除在研究之外。因此，45名（79%）接受FLST的患者被纳入研究。所有患者在医学上均无能力做出FLST决定。在24名（53%）患者中，在决定放弃治疗前与家属讨论了FLST。另外6个家属在做出FLST决定时无法联系，之后才进行了讨论。在15名患者中，未与家属进行讨论。接受美国培训的医生最初与29个家庭中的22个讨论了FLST，后来又与另外5个家庭讨论了（93%），而接受东欧培训的医生仅与16个家庭中的3个（19%）讨论了FLST（P<.001）。接受美国培训的医生的患者中有26名（90%）有FLST记录，接受东欧培训的医生的患者中有
