Ebell M H, Doukas D J, Smith M A
Department of Family Practice, University of Michigan, Ann Arbor.
Am J Med. 1991 Sep;91(3):255-60. doi: 10.1016/0002-9343(91)90124-g.
The purpose of this study was to compare the decision-making and preferences regarding do-not-resuscitate (DNR) orders of a group of family physicians with a group of out-patients from a family practice center. Complete results of the outpatient questionnaire were published in a previous study by the authors.
A random sample of 202 members of the Michigan Academy of Family Practice and all 32 members of the University of Michigan Department of Family Practice were surveyed by a mailed questionnaire. The questionnaire was divided into five parts: demographics, past experiences with DNR orders, who should be involved in DNR decision-making, values clarification, and a series of scenarios matched by a variety of biomedical and non-biomedical factors.
After eliminating physicians who had left no forwarding address or who had retired or died, the overall response rate was 61.8%. Most physicians (97%) had at some time written a DNR order for one of their patients; discussions most commonly took place in the hospital room. Physicians, like patients, thought that in addition to the patient, DNR decisions should involve the spouse, the physician, and the patient's children, respectively. Value clarification revealed that both groups most highly value "being able to think clearly" and "being treated with dignity." The presence of a number of quality-of-life issues (age, drug or alcohol use, wheelchair use, dementia, and severe pain) in a series of scenarios negatively affected the decision of both family physicians and patients to resuscitate.
There are significant similarities and differences in the way physicians and patients make DNR decisions. It is important that physicians and their patients communicate in a timely manner about prognosis, values, and quality-of-life issues in order to make effective DNR decisions.
本研究旨在比较一组家庭医生与一组来自家庭医疗中心的门诊患者在关于“不要复苏”（DNR）医嘱方面的决策制定和偏好。门诊患者问卷的完整结果已在作者之前的一项研究中发表。
通过邮寄问卷对密歇根家庭医生学会的202名成员随机样本以及密歇根大学家庭医学系的所有32名成员进行了调查。问卷分为五个部分：人口统计学、过去关于DNR医嘱的经历、谁应参与DNR决策制定、价值观澄清以及一系列由各种生物医学和非生物医学因素匹配的情景。
在剔除没有留下转寄地址、已退休或去世的医生后，总体回复率为61.8%。大多数医生（97%）曾在某个时候为他们的一名患者开具过DNR医嘱；讨论最常在病房进行。医生和患者一样，认为除患者外，DNR决策应分别涉及配偶、医生和患者的子女。价值观澄清显示，两组都最看重“能够清晰思考”和“受到尊严对待”。一系列情景中存在的一些生活质量问题（年龄、药物或酒精使用、轮椅使用、痴呆和剧痛）对家庭医生和患者进行复苏的决策产生了负面影响。
医生和患者在做出DNR决策的方式上存在显著异同。医生及其患者及时就预后、价值观和生活质量问题进行沟通，以便做出有效的DNR决策，这一点很重要。
