Kellogg F R, Crain M, Corwin J, Brickner P W
Department of Community Medicine, St Vincent's Hospital and Medical Center, New York, NY 10011.
Arch Intern Med. 1992 Nov;152(11):2317-20.
Engaging older persons in consideration of use of life-sustaining measures, such as cardiopulmonary resuscitation, tube feeding, and urgent intubation, is widely recommended, yet uncommon.
We studied the short-term impact of a physician-initiated discussion, geared toward guiding informed decision-making, with 20 frail elderly homebound patients. A battery of psychologic rating scales was administered in a pre-post design. Eighteen subjects completed the protocol. Fifteen of the mentally capable surviving subjects were reinterviewed 18 months following the initial discussion to evaluate durability of their decisions.
Most welcomed the discussion and clear choices regarding future care usually emerged. Depression rating scales decreased slightly for the entire sample. For the subgroup having relatively internal locus of control, there was an increase in life satisfaction scores. No patient demonstrated signs of emotional trauma consequent to the discussion. On follow-up, several patients were indecisive about their choices.
Involvement of these patients in decision-making appeared to have no adverse effects, and, for some, it was therapeutic, possibly through enhancement of personal control. Durability of their decisions was not a consistent finding, however.
广泛建议让老年人参与关于使用维持生命措施的考量，如心肺复苏、管饲和紧急插管，但实际情况并不常见。
我们研究了由医生发起的、旨在指导明智决策的讨论对20名体弱居家老年患者的短期影响。采用前后对照设计，使用了一系列心理评定量表。18名受试者完成了该方案。对15名有精神能力的存活受试者在初次讨论18个月后进行了再次访谈，以评估他们决策的持续性。
大多数人欢迎此次讨论，通常也能就未来护理做出明确选择。整个样本的抑郁评定量表得分略有下降。对于具有相对内控倾向的亚组，生活满意度得分有所提高。没有患者因讨论而出现情绪创伤迹象。在随访中，一些患者对自己的选择犹豫不决。
让这些患者参与决策似乎没有不良影响，而且对一些患者来说具有治疗作用，可能是通过增强个人掌控感实现的。然而，他们决策的持续性并非一致的结果。
