Davison Sara N, Jhangri Gian S, Holley Jean L, Moss Alvin H
Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada.
Clin J Am Soc Nephrol. 2006 Nov;1(6):1256-62. doi: 10.2215/CJN.02040606. Epub 2006 Sep 13.
Nephrologists commonly engage in end-of-life decision-making with patients with ESRD and their families. The purpose of this study was to determine the perceived preparedness of nephrologists to make end-of-life decisions and to determine factors that are associated with the highest level of perceived preparedness. The nephrologist members of the Renal Physicians Association (RPA) and the Canadian Society of Nephrology were invited to participate in an online survey of their end-of-life decision-making practices. A total of 39% of 360 respondents perceived themselves as very well prepared to make end-of-life decisions. Age >46 yr, six or more patients withdrawn from dialysis in the preceding year, and awareness of the RPA/American Society of Nephrology (ASN) guideline on dialysis decision-making were independently associated with the highest level of self-reported preparedness. Nephrologists who reported being very well prepared were more likely to use time-limited trials of dialysis and stop dialysis of a patient with permanent and severe dementia. Compared with Americans, Canadian nephrologists reported being equally prepared to make end-of-life decisions, stopped dialysis of a higher number of patients, referred fewer to hospice, and were more likely to stop dialysis of a patient with severe dementia. Nephrologists who have been in practice longer and are knowledgeable of the RPA/ASN guideline report greater preparedness to make end-of-life decisions and report doing so more often in accordance with guideline recommendations. To improve nephrologists' comfort with end-of-life decision-making, fellowship programs should teach the recommendations in the RPA/ASN guideline and position statement.
肾病学家通常会与终末期肾病患者及其家属共同参与临终决策。本研究的目的是确定肾病学家对做出临终决策的自我认知准备程度，并确定与最高水平的自我认知准备相关的因素。邀请了肾脏内科医师协会（RPA）和加拿大肾病学会的肾病学家成员参与一项关于其临终决策实践的在线调查。在360名受访者中，共有39%的人认为自己对做出临终决策准备充分。年龄>46岁、前一年有6名或更多患者停止透析以及知晓RPA/美国肾病学会（ASN）关于透析决策的指南，这些因素与自我报告的最高准备水平独立相关。报告准备充分的肾病学家更有可能采用限时透析试验，并停止为患有永久性严重痴呆症的患者透析。与美国肾病学家相比，加拿大肾病学家报告称在做出临终决策方面准备程度相当，停止透析的患者数量更多，转介至临终关怀机构的患者更少，并且更有可能停止为患有严重痴呆症的患者透析。从业时间更长且知晓RPA/ASN指南的肾病学家报告称在做出临终决策方面准备更充分，并且更常按照指南建议这样做。为提高肾病学家对临终决策的舒适度，专科培训项目应教授RPA/ASN指南和立场声明中的建议。
