O'Donnell Heather, Phillips Russell S, Wenger Neil, Teno Joan, Davis Roger B, Hamel Mary Beth
Washington University School of Medicine, USA.
J Am Med Dir Assoc. 2003 May-Jun;4(3):139-44. doi: 10.1097/01.JAM.0000064464.85732.45.
To describe the cardiopulmonary resuscitation (CPR) preferences of hospitalized patients aged 80 and older. To examine physicians' perceptions of their patients' preferences and agreement between patients' and physicians' preferences, estimation of prognosis, and assessment of quality of life.
Prospective cohort study.
Four academic hospitals.
Patients 80 years or older hospitalized between January 1993 and November 1994.
Detailed clinical data were collected by chart review and interview. Patients and physicians were interviewed to determine their preferences for cardiopulmonary resuscitation (CPR). Agreement between patients and physicians was assessed using the kappa statistic, which measures agreement beyond chance.
Of the 1266 patients studied, their median age was 85 years, and 61% were female. The majority (55%) of the 1010 patients with CPR preference information available desired CPR. Compared with patients, fewer physicians wanted CPR (36%) if they were in their patients' condition. Agreement between patients' preferences and physicians' perceptions of these preferences was low (absolute agreement 63%, kappa = 0.21). Agreement was better between physicians' perceptions of patients' preferences and physicians' desire for themselves if they were in their patients' condition (66%, kappa = 0.36). Agreement between patients' and physicians' estimates of survival was only slight (46%, kappa = 0.10). The majority of the disagreement occurred when the physician's prognostic estimate was worse than the patient's.
The majority of hospitalized patients 80 years older wanted CPR. When asked to imagine themselves in the same clinical situation as their patients, physicians were much less likely to want CPR and viewed CPR as undesirable for most patients. Physicians' estimates of patients' prognoses were less optimistic than patients' estimates, raising the possibility that physicians' knowledge of older patients' poor outcomes from CPR explains their lack of enthusiasm about CPR for most patients 80 years and older.
描述80岁及以上住院患者对心肺复苏（CPR）的偏好。研究医生对患者偏好的看法，以及患者与医生偏好之间的一致性、预后估计和生活质量评估。
前瞻性队列研究。
四家学术医院。
1993年1月至1994年11月期间住院的80岁及以上患者。
通过病历审查和访谈收集详细的临床数据。对患者和医生进行访谈，以确定他们对心肺复苏（CPR）的偏好。使用kappa统计量评估患者和医生之间的一致性，该统计量衡量的是超出偶然因素的一致性。
在研究的1266名患者中，他们的中位年龄为85岁，61%为女性。在1010名有CPR偏好信息的患者中，大多数（55%）希望进行CPR。与患者相比，如果处于患者的病情状况，较少的医生希望进行CPR（36%）。患者偏好与医生对这些偏好的看法之间的一致性较低（绝对一致性为63%，kappa = 0.21）。医生对患者偏好的看法与医生假设自己处于患者病情状况时的自身意愿之间的一致性较好（66%，kappa = 0.36）。患者和医生对生存的估计之间的一致性仅为轻微（46%，kappa = 0.10）。大多数分歧发生在医生的预后估计比患者的更差时。
大多数80岁及以上的住院患者希望进行CPR。当被要求想象自己处于与患者相同的临床情况时，医生进行CPR的意愿要低得多，并认为对大多数患者来说CPR是不可取的。医生对患者预后的估计不如患者乐观，这增加了一种可能性，即医生了解老年患者CPR的不良结果解释了他们对大多数80岁及以上患者进行CPR缺乏热情的原因。
