Song Mi-Kyung, Ward Sandra E
School of Nursing, University of North Carolina, Chapel Hill, NC, USA.
Palliat Med. 2013 Sep;27(8):789-92. doi: 10.1177/0269216312474486. Epub 2013 Feb 1.
The role played by emergency contacts can be extensive particularly for chronically seriously ill patients. If the patient's condition suddenly deteriorates, the emergency contact may be asked to make decisions that should instead fall to a designated surrogate decision-maker.
To describe a process used to help chronically seriously ill patients identify a surrogate during study enrollment and to describe whether these surrogates were the same as the documented emergency contacts.
A descriptive cross-sectional study using eligibility assessment and baseline data from an efficacy trial. The parent trial tests the effects of an end-of-life communication intervention on patient and surrogate decision-maker outcomes, and thus, it was important to identify the surrogate. The study recruiter used a short battery of investigator-developed questions to help patients identify a surrogate.
SETTING/PARTICIPANTS: Patients were 94 self-identified African Americans or Caucasians recruited from 18 outpatient dialysis centers, receiving dialysis for ≥6 months, with Charlson Comorbidity Index of ≥6 or 5 and hospitalized in the last 6 months.
When first approached, only three patients had a designated and documented surrogate. The remaining 91 selected a surrogate during the surrogate identification process. Of the 94 surrogates who were named, only 60 (63.8%) were also listed in the medical record as the emergency contact.
In roughly one-third of instances, the selected surrogate was not the same person listed in official medical records as the emergency contact, which may pose potential problems in medical decision-making in the absence of advance directives.
紧急联系人所扮演的角色可能非常广泛，尤其是对于患有慢性重症的患者。如果患者病情突然恶化，可能会要求紧急联系人做出本应由指定替代决策者做出的决定。
描述在研究入组期间用于帮助患有慢性重症的患者确定替代决策者的过程，并描述这些替代决策者是否与记录在案的紧急联系人相同。
一项描述性横断面研究，使用来自一项疗效试验的资格评估和基线数据。母试验测试临终沟通干预对患者和替代决策者结果的影响，因此，确定替代决策者很重要。研究招募人员使用了一系列由研究人员制定的简短问题来帮助患者确定替代决策者。
设置/参与者：患者为94名自我认定的非裔美国人或高加索人，从18个门诊透析中心招募，接受透析≥6个月，查尔森合并症指数≥6或5，且在过去6个月内住院。
初次接触时，只有三名患者有指定并记录在案的替代决策者。其余91名患者在替代决策者识别过程中选择了一名替代决策者。在被提名的94名替代决策者中，只有60名（63.8%）在病历中也被列为紧急联系人。
在大约三分之一的情况下，选定的替代决策者与官方病历中列为紧急联系人的不是同一人，这在没有预先指示的情况下可能会给医疗决策带来潜在问题。
