Deep Kristy S, Griffith Charles H, Wilson John F
University of Kentucky College of Medicine, Lexington, KY 40536, USA.
J Crit Care. 2009 Mar;24(1):141-4. doi: 10.1016/j.jcrc.2007.12.012. Epub 2008 Apr 18.
Resident physicians' beliefs about cardiopulmonary resuscitation (CPR) may impact their communication with patients about end-of-life care. We sought to understand how these perceptions and experiences have changed in the past decade because both medical education and American society have focused more on this domain.
We surveyed 2 internal medicine resident cohorts at a large academic medical center in 1995 and 2005. Residents were asked of their beliefs about survival after CPR, perceived patient understanding, and regret after attempted resuscitation. Residents in 2005 reported more numerical experience with CPR. Current internal medicine residents are more optimistic than the 1995 cohort about survival after an inpatient cardiac arrest. They believe that far fewer patients and families understand resuscitation but report less regret about attempting to resuscitate patients.
These pilot data reveal potential changes in the attitudes of resident physicians toward CPR. The perceived poor understanding among decision makers calls into question the standard of informed consent. Despite this, residents report less regret leading one to ask what factors may underlie this response.
住院医师对心肺复苏(CPR)的看法可能会影响他们与患者就临终关怀进行的沟通。我们试图了解在过去十年中,由于医学教育和美国社会都更加关注这一领域,这些认知和经历发生了怎样的变化。
我们在1995年和2005年对一家大型学术医疗中心的两组内科住院医师进行了调查。询问住院医师对心肺复苏后生存的看法、患者的理解程度以及复苏尝试后的遗憾程度。2005年的住院医师报告了更多关于心肺复苏的实际经验。与1995年那组相比,目前的内科住院医师对住院心脏骤停后的生存更为乐观。他们认为,理解复苏的患者和家属要少得多,但对尝试为患者进行复苏的遗憾程度较低。
这些初步数据揭示了住院医师对心肺复苏态度的潜在变化。决策者认为患者理解不足,这对知情同意的标准提出了质疑。尽管如此,住院医师报告的遗憾较少,这让人不禁要问,这种反应背后可能有哪些因素。