University Medical Center Goettingen, Germany.
Palliat Med. 2012 Oct;26(7):908-16. doi: 10.1177/0269216311419885. Epub 2011 Aug 24.
Advance directives and palliative crisis cards are means by which palliative care patients can exert their autonomy in end-of-life decisions.
To examine paramedics' attitudes towards advance directives and end-of-life care.
Questionnaire-based investigation using a self-administered survey instrument.
SETTING/PARTICIPANTS: Paramedics of two cities (Hamburg and Goettingen, Germany) were included. Participants were questioned as to (1) their attitudes about advance directives, (2) their clinical experiences in connection with end-of-life situations (e.g. resuscitation), (3) their suggestions in regard to advance directives, 'Do not attempt resuscitation' orders and palliative crisis cards.
Questionnaires were returned by 728 paramedics (response rate: 81%). The majority of paramedics (71%) had dealt with advance directives and end-of-life decisions in emergency situations. Most participants (84%) found that cardiopulmonary resuscitation in end-of-life patients is not useful and 75% stated that they would withhold cardiopulmonary resuscitation in the case of legal possibility. Participants also mentioned that more extensive discussion of legal aspects concerning advance directives should be included in paramedic training curricula. They suggested that palliative crisis cards should be integrated into end-of-life care.
Decision making in prehospital end-of-life care is a challenge for all paramedics. The present investigation demonstrates that a dialogue bridging emergency medical and palliative care issues is necessary. The paramedics indicated that improved guidelines on end-of-life decisions and the termination of cardiopulmonary resuscitation in palliative care patients may be essential. Participants do not feel adequately trained in end-of-life care and the content of advance directives. Other recent studies have also demonstrated that there is a need for training curricula in end-of-life care for paramedics.
预立医疗指示和缓和医疗危机卡是缓和医疗患者能够在临终决策中行使自主权的方式。
调查急救医疗技术员对预立医疗指示和临终关怀的态度。
使用自我管理调查工具进行基于问卷的调查。
地点/参与者：纳入了两个城市（德国汉堡和哥廷根）的急救医疗技术员。参与者被问及以下问题：（1）他们对预立医疗指示的态度，（2）他们在临终情况下（例如复苏）的临床经验，（3）他们对预立医疗指示、“不尝试复苏”命令和缓和医疗危机卡的建议。
共收回 728 名急救医疗技术员的问卷（应答率：81%）。大多数急救医疗技术员（71%）在紧急情况下处理过预立医疗指示和临终决策。大多数参与者（84%）认为心肺复苏术在临终患者中没有用处，75%的人表示如果有法律可能性，他们将不进行心肺复苏术。参与者还提到，应在急救医疗技术员培训课程中纳入更多关于预立医疗指示法律方面的讨论。他们建议将缓和医疗危机卡纳入临终关怀。
在院前临终关怀决策中，决策具有挑战性。本调查表明，有必要进行跨越急救医疗和缓和医疗问题的对话。急救医疗技术员表示，改善临终决策指南以及缓和医疗患者心肺复苏术的终止可能至关重要。参与者觉得自己在临终关怀和预立医疗指示内容方面的培训不足。其他最近的研究也表明，急救医疗技术员需要接受临终关怀培训课程。
