Center for Surgery and the Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
J Surg Educ. 2010 Mar-Apr;67(2):79-84. doi: 10.1016/j.jsurg.2010.01.002.
Twenty percent of Americans die in the intensive care unit of our nation's hospitals. Many of those individuals die after life-sustaining therapy has been withdrawn or withheld. Surgeons should be competent in discussing the withholding and withdrawal of life sustaining therapy (WWLST) with their patients. We surveyed surgical residents to learn their perspectives and training experience with discussing end-of-life care and WWLST with patients.
We mailed a survey to residents in all accredited surgical residency programs in New England. Nonresponders were contacted by mail at 3 and 6 weeks after the initial mailing.
Nineteen of 20 (95%) programs participated in this study. Three hundred thirty-five residents were surveyed and 141 residents responded (response rate, 42%). Ninety-two percent (n = 129) of respondents had cared for patients where WWLST had occurred, and 74% (n = 104) had initiated a discussion about WWLST themselves. Most (n = 81, 60%) respondents felt competent to discuss WWLST, whereas 14% rarely (n = 13) or never (n = 6) felt comfortable discussing WWLST. Most (n = 119, 85%) respondents believed that they would be adequately trained at the end of their residencies; however, 39% (n = 53) felt they were inadequately trained in this area. Graduates before 2002 were significantly more likely to agree strongly or generally that they would be well trained in managing WWLST when they completed residency (p = 0.006).
Almost all surgical residents will have to discuss WWLST with patients and their families, yet a significant number feel inadequately trained to do so. Steps should be taken to ensure that surgical residents can discuss WWLST as part of their core competencies, and this training should be reinforced throughout residency.
美国 20%的人在医院的重症监护病房去世。其中许多人在停止或撤回生命维持治疗后死亡。外科医生应该能够与患者讨论停止和撤回生命维持治疗（WWLST）。我们调查了外科住院医师，以了解他们在与患者讨论临终关怀和 WWLST 方面的观点和培训经验。
我们向新英格兰所有认证的外科住院医师培训计划的住院医师邮寄了一份调查。对未回复的人在初次邮寄后 3 周和 6 周通过邮件进行联系。
20 个计划中有 19 个（95%）参与了这项研究。对 335 名住院医师进行了调查，有 141 名住院医师做出了回应（回应率为 42%）。92%（n = 129）的受访者曾照顾过接受 WWLST 的患者，74%（n = 104）曾自行发起过 WWLST 讨论。大多数（n = 81，60%）受访者认为自己有能力讨论 WWLST，而 14%（n = 13）很少或从未（n = 6）感到舒适讨论 WWLST。大多数（n = 119，85%）受访者认为他们在住院医师培训结束时将得到充分培训；然而，39%（n = 53）认为他们在这方面的培训不足。2002 年之前毕业的毕业生更有可能强烈或普遍认为他们在完成住院医师培训后能够很好地处理 WWLST（p = 0.006）。
几乎所有的外科住院医师都将不得不与患者及其家属讨论 WWLST，但相当一部分人认为自己没有足够的能力这样做。应采取措施确保外科住院医师能够将 WWLST 讨论作为其核心能力的一部分，并且在整个住院医师培训期间都应加强这种培训。
