Brunetti L L, Carperos S D, Westlund R E
Department of Internal Medicine, Carolinas Medical Center, Charlotte, NC 28232-2861.
J Gen Intern Med. 1991 Jul-Aug;6(4):323-9. doi: 10.1007/BF02597430.
To determine whether a physician's familiarity with the living will directly relates to an expressed willingness to discuss resuscitation issues with patients.
Survey of selected primary care and medical sub-specialist physicians most likely to care for seriously or terminally ill patients.
Private-practice clinicians practicing in an urban county.
Internists, family practitioners, cardiologists, oncologists, and neurologists in private practice.
None.
Almost all responding physicians (97.2%) knew of the living will, although few (13.5%) had executed one for themselves. Most were willing to keep a copy of their patients' living wills with their office records. However, only a few physicians (20%) indicated they routinely discussed extraordinary care issues with their patients. In fact, most (70%) reported they rarely or never discussed cardiopulmonary resuscitation (CPR) with their patients. With terminally ill patients, physician initiative was greater: 69% reported discussing resuscitation preferences. Comparable discussions with elderly patients were undertaken only if the physician believed they would be warranted by the clinical circumstances. When questioned about their own sentiments towards resuscitation, most physicians indicated they would not want CPR if they were terminally ill (86%) or mentally incompetent (93%). A similar number (92%) would refuse artificial feeding if permanently comatose.
Many physicians recognize the importance of living wills as an expression of patient treatment preferences. Nevertheless, discussion of patient preferences is unlikely because of physicians' reluctance, except in limited circumstances, to initiate a dialogue about life-sustaining measures. Because patients also are often unwilling to begin such discussions, better methods of facilitating discussion of CPR and other extraordinary health care measures must be sought.
确定医生对生前预嘱的熟悉程度是否与表达出的与患者讨论复苏问题的意愿直接相关。
对最有可能照料重症或绝症患者的初级保健医生和医学专科医生进行调查。
在城市县执业的私人执业临床医生。
私人执业的内科医生、家庭医生、心脏病专家、肿瘤学家和神经科医生。
无。
几乎所有回复的医生（97.2%）都知道生前预嘱，尽管很少有人（13.5%）为自己立过一份。大多数医生愿意将患者的生前预嘱副本保存在办公室记录中。然而，只有少数医生（20%）表示他们会定期与患者讨论特殊护理问题。事实上，大多数医生（70%）报告说他们很少或从不与患者讨论心肺复苏（CPR）。对于绝症患者，医生的主动性更强：69%的医生报告说讨论过复苏偏好。只有当医生认为临床情况需要时，才会与老年患者进行类似的讨论。当被问及他们自己对复苏的看法时，大多数医生表示，如果他们身患绝症（86%）或精神不健全（93%），他们不希望进行心肺复苏。类似比例（92%）的医生表示，如果永久昏迷，他们会拒绝人工喂养。
许多医生认识到生前预嘱作为患者治疗偏好表达的重要性。然而，由于医生不愿主动发起关于维持生命措施的对话，除了在有限的情况下，患者偏好的讨论不太可能进行。由于患者通常也不愿意开始此类讨论，因此必须寻求更好的方法来促进关于心肺复苏和其他特殊医疗措施的讨论。
