一项针对住院患者的心肺复苏和插管视频决策支持工具的随机对照试验。
A Randomized Controlled Trial of a CPR and Intubation Video Decision Support Tool for Hospitalized Patients.
作者信息
El-Jawahri Areej, Mitchell Susan L, Paasche-Orlow Michael K, Temel Jennifer S, Jackson Vicki A, Rutledge Renee R, Parikh Mihir, Davis Aretha D, Gillick Muriel R, Barry Michael J, Lopez Lenny, Walker-Corkery Elizabeth S, Chang Yuchiao, Finn Kathleen, Coley Christopher, Volandes Angelo E
机构信息
Hematology-Oncology Department, Massachusetts General Hospital, 55 Fruit Street, Cox 120, Boston, MA, 02114, USA,
出版信息
J Gen Intern Med. 2015 Aug;30(8):1071-80. doi: 10.1007/s11606-015-3200-2. Epub 2015 Feb 18.
BACKGROUND
Decisions about cardiopulmonary resuscitation (CPR) and intubation are a core part of advance care planning, particularly for seriously ill hospitalized patients. However, these discussions are often avoided.
OBJECTIVES
We aimed to examine the impact of a video decision tool for CPR and intubation on patients' choices, knowledge, medical orders, and discussions with providers.
DESIGN
This was a prospective randomized trial conducted between 9 March 2011 and 1 June 2013 on the internal medicine services at two hospitals in Boston.
PARTICIPANTS
One hundred and fifty seriously ill hospitalized patients over the age of 60 with an advanced illness and a prognosis of 1 year or less were included. Mean age was 76 and 51% were women.
INTERVENTION
Three-minute video describing CPR and intubation plus verbal communication of participants' preferences to their physicians (intervention) (N = 75) or control arm (usual care) (N = 75).
MAIN MEASURES
The primary outcome was participants' preferences for CPR and intubation (immediately after viewing the video in the intervention arm). Secondary outcomes included: orders to withhold CPR/intubation, documented discussions with providers during hospitalization, and participants' knowledge of CPR/ intubation (five-item test, range 0-5, higher scores indicate greater knowledge).
RESULTS
Intervention participants (vs. controls) were more likely not to want CPR (64% vs. 32%, p <0.0001) and intubation (72% vs. 43%, p < 0.0001). Intervention participants (vs. controls) were also more likely to have orders to withhold CPR (57% vs. 19%, p < 0.0001) and intubation (64% vs.19%, p < 0.0001) by hospital discharge, documented discussions about their preferences (81% vs. 43%, p < 0.0001), and higher mean knowledge scores (4.11 vs. 2.45; p < 0.0001).
CONCLUSIONS
Seriously ill patients who viewed a video about CPR and intubation were more likely not to want these treatments, be better informed about their options, have orders to forgo CPR/ intubation, and discuss preferences with providers.
TRIAL REGISTRATION
Clinicaltrials.gov NCT01325519 Registry Name: A prospective randomized trial using video images in advance care planning in seriously ill hospitalized patients.
背景
关于心肺复苏（CPR）和插管的决策是预先护理计划的核心部分，特别是对于重症住院患者。然而，这些讨论往往被回避。
目的
我们旨在研究CPR和插管视频决策工具对患者选择、知识、医嘱以及与医护人员讨论的影响。
设计
这是一项前瞻性随机试验，于2011年3月9日至2013年6月1日在波士顿两家医院的内科病房进行。
参与者
纳入150名60岁以上患有晚期疾病且预后为1年或更短的重症住院患者。平均年龄为76岁，51%为女性。
干预措施
观看一段描述CPR和插管的三分钟视频，并将参与者的偏好口头告知其医生（干预组）（N = 75）或对照组（常规护理）（N = 75）。
主要测量指标
主要结局是参与者对CPR和插管的偏好（干预组观看视频后立即进行评估）。次要结局包括：下达不进行CPR/插管的医嘱、住院期间与医护人员进行记录在案的讨论，以及参与者对CPR/插管的知识（五项测试，范围为0 - 5，分数越高表明知识掌握程度越高）。
结果
干预组参与者（与对照组相比）更有可能不希望进行CPR（64%对32%，p <0.0001）和插管（72%对43%，p <0.0001）。到出院时，干预组参与者（与对照组相比）也更有可能有下达不进行CPR（57%对19%，p <0.0001）和插管（64%对19%，p <0.0001）的医嘱，有关于其偏好的记录在案的讨论（81%对43%，p <0.0001），且平均知识得分更高（4.11对2.45；p <0.0001）。
结论
观看关于CPR和插管视频的重症患者更有可能不希望接受这些治疗，对其选择有更充分的了解，有不进行CPR/插管的医嘱，并与医护人员讨论偏好。
试验注册
Clinicaltrials.gov NCT01325519 注册名称：一项在重症住院患者预先护理计划中使用视频图像的前瞻性随机试验。
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