Siddiqui Mohammad F, Holley Jean L
University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Am J Hosp Palliat Care. 2011 Mar;28(2):94-7. doi: 10.1177/1049909110374599. Epub 2010 Aug 27.
Although ''Do not resuscitate'' (DNR) orders are among the most commonly discussed patient preference treatment measures, few studies have assessed internal medicine residents' views on this complex topic. Our objective was to assess resident practices in establishing code status. We also examined resident training and experiences in pronouncing death.
An 18-question survey addressing DNR discussions and pronouncing death was emailed to internal medicine residents in the state of Illinois. Each question had multiple-choice options.
A total of 175 residents completed the questionnaire (22% response rate). Seventy-eight percent of the residents had discussed DNR status with patients or their families at least 9 times. However, only one third of the residents felt very comfortable in such discussions. Only 26% of the residents had been observed by a faculty member during a code status discussion and fewer (16%) while pronouncing death. Do not resuscitate discussions rarely occurred in an outpatient clinic (27%). Most residents (90%) thought they would benefit from formal training in DNR discussion.
Although most residents discuss DNR status with patients and families, only a quarter are observed in such discussions by attending physicians and only a third feel comfortable with this aspect of clinical care. Developing a structured residency program curriculum to address resident skills in end-of-life care would benefit residency training.
尽管“不要复苏”（DNR）医嘱是最常讨论的患者偏好治疗措施之一，但很少有研究评估内科住院医师对这个复杂话题的看法。我们的目的是评估住院医师在确定抢救状态方面的做法。我们还研究了住院医师在宣布死亡方面的培训和经验。
向伊利诺伊州的内科住院医师发送了一份包含18个问题的关于DNR讨论和宣布死亡的调查问卷。每个问题都有多项选择。
共有175名住院医师完成了问卷（回复率为22%）。78%的住院医师至少与患者或其家属讨论过9次DNR状态。然而，只有三分之一的住院医师在这类讨论中感到非常自在。只有26%的住院医师在抢救状态讨论期间被教员观察过，而在宣布死亡时被观察的更少（16%）。在门诊很少进行“不要复苏”讨论（27%）。大多数住院医师（90%）认为他们将从DNR讨论的正规培训中受益。
尽管大多数住院医师会与患者及其家属讨论DNR状态，但只有四分之一的住院医师在这类讨论中被主治医生观察到，并且只有三分之一的住院医师对临床护理的这一方面感到自在。制定一个结构化的住院医师培训课程以提高住院医师在临终关怀方面的技能将有利于住院医师培训。
