Frankl D, Oye R K, Bellamy P E
Department of Medicine, UCLA School of Medicine 90024-1685.
Am J Med. 1989 Jun;86(6 Pt 1):645-8.
Life-support decisions have profound medical, ethical, and economic implications; yet little is known about inpatients' preferences for life-sustaining treatments. We therefore conducted a prospective survey of medical inpatients to determine attitudes toward life support under differing medical outcomes, and the extent of physician communication about these issues.
The study population consisted of 200 adult patients admitted to the general medical services at UCLA Medical Center during August and September 1987. Each patient completed a standardized 13-item questionnaire. Patients rated their agreement with life-support treatment in the context of four outcome scenarios. A five-point Lickert scale for each question was used, and an overall life-support scale was created by summing the four items. Patients were also asked about previous life-support discussions with their physicians.
Life support was desired in 90 percent of the patients if their health could be restored to its usual level, in 30 percent if they would be unable to care for themselves after discharge, in 16 percent if their chance for recovery was hopeless, and in only 6 percent if they would remain in a vegetative state. Patients who desired less aggressive care were older, female, and more likely to have terminal illnesses. Only 16 percent reported having discussed life support with their physicians; however, an additional 47 percent desired such discussions.
Hospitalized medical patients base their preferences for life support upon perceived outcomes. Lack of communication creates the potential for patients to be subjected to burdensome and expensive treatments they may not desire. We encourage physicians to offer their patients discussions about prognosis and the efficacy of life support so that disproportionate treatments can be avoided.
维持生命的决策具有深远的医学、伦理和经济意义；然而，对于住院患者对维持生命治疗的偏好却知之甚少。因此，我们对内科住院患者进行了一项前瞻性调查，以确定他们在不同医疗结果下对生命支持的态度，以及医生就这些问题进行沟通的程度。
研究对象包括1987年8月和9月入住加州大学洛杉矶分校医疗中心普通内科的200名成年患者。每位患者都完成了一份标准化的包含13个条目的问卷。患者在四种结果情景下对维持生命治疗的同意程度进行评分。每个问题使用五分制李克特量表，并通过对四个项目求和创建一个总体生命支持量表。患者还被问及之前与医生关于生命支持的讨论情况。
如果健康能恢复到正常水平，90%的患者希望维持生命；如果出院后无法自理，30%的患者希望维持生命；如果康复希望渺茫，16%的患者希望维持生命；如果将处于植物人状态，只有6%的患者希望维持生命。希望采取较保守治疗的患者年龄较大、为女性且更有可能患有晚期疾病。只有16%的患者报告曾与医生讨论过生命支持问题；然而，另有47%的患者希望进行此类讨论。
住院内科患者对生命支持的偏好基于他们所感知的结果。缺乏沟通可能使患者接受他们可能不希望的繁重且昂贵的治疗。我们鼓励医生与患者讨论预后及生命支持的效果，以避免过度治疗。
