Deep Kristy S, Green Sharon F, Griffith Charles H, Wilson John F
Department of Internal Medicine, University of Kentucky, Lexington, Kentucky 40536, USA.
J Palliat Med. 2007 Jun;10(3):712-20. doi: 10.1089/jpm.2006.0220.
Resident physicians are inadequately taught how to communicate with patients about end-of-life decision making. Their beliefs about resuscitation and prior experiences with end-of-life care may impact the manner in which they approach patients.
To explore residents' perceptions of end-of-life discussions, determine the features they find most important, and discern the challenges they face in this process.
Internal medicine residents were surveyed about their experiences discussing resuscitation with patients including perceptions of patient understanding, outcomes of resuscitation, and regret about attempting to resuscitate patients. They were asked what features of these discussions are most important and which are the most challenging. Qualitative content analysis was used to examine the responses to open-ended questions.
Fifty-five residents completed the survey. Residents reported rarely feeling satisfied with the results of these discussions and disagreed with the decision for resuscitation numerous times. They perceive that few patients and families understand resuscitation. In their description of important features, they focus on the content of the discussion rather than the process, with the most common responses centering on a description of resuscitation. In contrast, the greatest challenge they identify is dealing with the emotional aspects of the discussion.
Residents report internal conflict about their experiences discussing resuscitation with patients. Their approach to these discussions focuses on resuscitation itself with less attention paid to processes that might improve patient decision making. The challenges they describe may be overcome with improved education about end-of-life communication.
住院医师在如何与患者就临终决策进行沟通方面所接受的培训不足。他们对复苏的看法以及以往的临终护理经历可能会影响他们与患者沟通的方式。
探讨住院医师对临终讨论的看法，确定他们认为最重要的特征，并识别他们在此过程中面临的挑战。
对内科学住院医师进行调查，了解他们与患者讨论复苏的经历，包括对患者理解程度的看法、复苏结果以及对尝试复苏患者的遗憾。询问他们这些讨论的哪些特征最重要，哪些最具挑战性。采用定性内容分析法检查对开放式问题的回答。
55名住院医师完成了调查。住院医师表示很少对这些讨论的结果感到满意，并且多次不同意复苏决定。他们认为很少有患者和家属理解复苏。在描述重要特征时，他们关注讨论的内容而非过程，最常见的回答集中在对复苏的描述上。相比之下，他们认为最大的挑战是应对讨论中的情感方面。
住院医师报告在与患者讨论复苏的经历中存在内心冲突。他们对这些讨论的方式侧重于复苏本身，而对可能改善患者决策的过程关注较少。通过加强临终沟通教育，他们所描述的挑战或许可以得到克服。
