Dunlay Shannon M, Foxen Jilian L, Cole Terese, Feely Molly A, Loth Ann R, Strand Jacob J, Wagner Jean A, Swetz Keith M, Redfield Margaret M
Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Palliat Med. 2015 Mar;29(3):260-7. doi: 10.1177/0269216314556565. Epub 2014 Dec 8.
As heart failure often follows an unpredictable clinical trajectory, there has been an impetus to promote iterative patient-provider discussions regarding prognosis and preferences for end-of-life care.
To examine clinicians' practices, expectations, and personal level of confidence in discussing goals of care and providing end-of-life care to their patients with heart failure.
Multi-site clinician survey.
Physicians, nurse practitioners, and physician assistants at Mayo Clinic (Rochester, Minnesota, USA) and its surrounding health system were asked to participate in an electronic survey in October 2013. Tertiary Care Cardiology, Community Cardiology, and Primary Care clinicians were surveyed.
A total of 95 clinicians participated (52.5% response rate). Only 12% of clinicians reported having annual end-of-life discussions as advocated by the American Heart Association. In total, 52% of clinicians hesitated to discuss end-of-life care citing provider discomfort (11%), perception of patient (21%) or family (12%) unreadiness, fear of destroying hope (9%), or lack of time (8%). Tertiary and Community Cardiology clinicians (66%) attributed responsibility for end-of-life discussions to the heart failure cardiologist, while 66% of Primary Care clinicians felt it was their responsibility. Overall, 30% of clinicians reported a low or very low level of confidence in one or more of the following: initiating prognosis or end-of-life discussions, enrolling patients in hospice, or providing end-of-life care. Most clinicians expressed interest in further skills acquisition.
Clinicians vary in their views and approaches to end-of-life discussions and care. Some lack confidence and most are interested in further skills acquisition.
由于心力衰竭往往遵循不可预测的临床病程，因此推动医患之间就预后和临终关怀偏好进行反复讨论的动力一直存在。
研究临床医生在讨论心力衰竭患者的护理目标和提供临终关怀方面的实践、期望以及个人信心水平。
多中心临床医生调查。
2013年10月，美国明尼苏达州罗切斯特市梅奥诊所及其周边医疗系统的医生、执业护士和医师助理被邀请参与一项电子调查。对三级护理心脏病学、社区心脏病学和初级护理临床医生进行了调查。
共有95名临床医生参与（回复率为52.5%）。只有12%的临床医生报告按照美国心脏协会的倡导进行年度临终讨论。总体而言，52%的临床医生因以下原因而对讨论临终关怀犹豫不决：医生感到不适（11%）、认为患者（21%）或家属（12%）未做好准备、担心破坏希望（9%）或缺乏时间（8%）。三级护理和社区心脏病学临床医生（66%）将临终讨论的责任归于心力衰竭心脏病专家，而66%的初级护理临床医生认为这是他们的责任。总体而言，30%的临床医生报告在以下一项或多项方面信心较低或非常低：启动预后或临终讨论、让患者入住临终关怀机构或提供临终关怀。大多数临床医生表示有兴趣进一步获取相关技能。
临床医生在临终讨论和护理的观点及方法上存在差异。一些人缺乏信心，大多数人有兴趣进一步获取相关技能。
