Ackroyd Rajeena, Russon Lynne, Newell Rob
Bradford Teaching Hospitals NHS Trust, Bradford.
Palliat Med. 2007 Mar;21(2):139-44. doi: 10.1177/0269216306074629.
Doctors are justified withholding a treatment, such as cardiopulmonary resuscitation (CPR), if it is unlikely to benefit a patient. The success rates for CPR in patients with cancer is <1%. Guidelines produced in 2001 recommended that CPR should be discussed with patients, even when it is unlikely to be successful. Therefore, should oncologists always discuss resuscitation, even when it is likely to be futile?
Sixty oncology in-patients and 32 of their relatives were asked their views on CPR, and their views were compared with the oncologist involved in their care.
Some 58% of patients wanted to be resuscitated. There was a moderate-strong correlation between patients and their next of kin and the desire for resuscitation. There was also a positive correlation between the doctor's views on suitability for resuscitation, patient's prognostic score, and World Health Organisation (WHO) performance score.
Most patients wanted to be resuscitated despite being given the likely poor survival rates from CPR. They also wanted to be involved in the decision-making process, and wanted their next of kin involved, even when, medically, the procedure was unlikely to be successful. The findings that patient and next of kin views correlated well shows that relatives' views are a good representation of patient views. In contrast, consultant's decisions were strongly correlated with the patient's performance status and clinical state. No patients were upset by the study, although nine patients declined to participate.
如果某种治疗方法（如心肺复苏术，CPR）对患者不太可能有益，医生有理由不采用该治疗方法。癌症患者心肺复苏术的成功率<1%。2001年制定的指南建议，即使心肺复苏术不太可能成功，也应与患者讨论该治疗方法。那么，肿瘤学家是否应该总是讨论复苏问题，即使该方法可能无效？
询问了60名肿瘤住院患者及其32名亲属对心肺复苏术的看法，并将他们的看法与负责其治疗的肿瘤学家的看法进行了比较。
约58%的患者希望接受复苏。患者与其近亲之间以及对复苏的渴望之间存在中度至强相关性。医生对复苏适宜性的看法、患者的预后评分以及世界卫生组织（WHO）的表现评分之间也存在正相关。
尽管已知心肺复苏术的生存率可能较低，但大多数患者仍希望接受复苏。他们还希望参与决策过程，并希望其近亲参与，即使从医学角度来看该操作不太可能成功。患者和近亲观点相关性良好的研究结果表明，亲属的观点很好地代表了患者的观点。相比之下，顾问的决定与患者的表现状态和临床状况密切相关。尽管有9名患者拒绝参与，但没有患者因该研究而感到不安。
