Schneiderman Lawrence J, Gilmer Todd, Teetzel Holly D, Dugan Daniel O, Blustein Jeffrey, Cranford Ronald, Briggs Kathleen B, Komatsu Glen I, Goodman-Crews Paula, Cohn Felicia, Young Ernlé W D
Department of Family and Preventive Medicine, University of California, San Diego, La Jolla 92093, USA.
JAMA. 2003 Sep 3;290(9):1166-72. doi: 10.1001/jama.290.9.1166.
Ethics consultations increasingly are being used to resolve conflicts about life-sustaining interventions, but few studies have reported their outcomes.
To investigate whether ethics consultations in the intensive care setting reduce the use of life-sustaining treatments delivered to patients who ultimately did not survive to hospital discharge, as well as the reactions to the consultations of physicians, nurses, and patients/surrogates.
Prospective, multicenter, randomized controlled trial from November 2000 to December 2002.
Adult intensive care units (ICUs) of 7 US hospitals representing a spectrum of institutional characteristics.
Five hundred fifty-one patients in whom value-related treatment conflicts arose during the course of treatment.
Patients were randomly assigned either to an intervention (ethics consultation offered) (n = 278) or to usual care (n = 273).
The primary outcomes were ICU days and life-sustaining treatments in those patients who did not survive to hospital discharge. We examined the same measures in those who did survive to discharge and also compared the overall mortality rates of the intervention and usual care groups. We also interviewed physicians and nurses and patients/surrogates about their views of the ethics consultation.
The intervention and usual-care groups showed no difference in mortality. However, ethics consultations were associated with reductions in hospital (-2.95 days, P =.01) and ICU (-1.44 days, P =.03) days and life-sustaining treatments (-1.7 days with ventilation, P =.03) in those patients who ultimately did not survive to discharge. The majority (87%) of physicians, nurses, and patients/surrogates agreed that ethics consultations in the ICU were helpful in addressing treatment conflicts.
Ethics consultations were useful in resolving conflicts that may have inappropriately prolonged nonbeneficial or unwanted treatments in the ICU.
伦理会诊越来越多地被用于解决关于维持生命干预措施的冲突，但很少有研究报告其结果。
调查重症监护环境中的伦理会诊是否能减少对最终未存活至出院患者的维持生命治疗的使用，以及医生、护士和患者/代理人对会诊的反应。
2000年11月至2002年12月的前瞻性、多中心、随机对照试验。
美国7家具有不同机构特征的医院的成人重症监护病房（ICU）。
551名在治疗过程中出现与价值观相关的治疗冲突的患者。
患者被随机分配到干预组（提供伦理会诊）（n = 278）或常规治疗组（n = 273）。
主要结局是未存活至出院患者的ICU住院天数和维持生命治疗。我们对存活至出院的患者也检查了相同的指标，并比较了干预组和常规治疗组的总体死亡率。我们还就医生、护士以及患者/代理人对伦理会诊的看法进行了访谈。
干预组和常规治疗组在死亡率方面没有差异。然而，伦理会诊与最终未存活至出院患者的住院天数（减少2.95天，P = 0.01）、ICU住院天数（减少1.44天，P = 0.03）以及维持生命治疗（机械通气减少1.7天，P = 0.03）的减少有关。大多数（87%）医生、护士和患者/代理人认为ICU中的伦理会诊有助于解决治疗冲突。
伦理会诊有助于解决可能不适当地延长了ICU中无益处或不必要治疗的冲突。
