第八项三元组研究：全国多中心评估，以确定患者视频推荐能否安全地有助于确保适当的重症与临终关怀。

TRIAD VIII: Nationwide Multicenter Evaluation to Determine Whether Patient Video Testimonials Can Safely Help Ensure Appropriate Critical Versus End-of-Life Care.

作者信息

Mirarchi Ferdinando L, Cooney Timothy E, Venkat Arvind, Wang David, Pope Thaddeus M, Fant Abra L, Terman Stanley A, Klauer Kevin M, Williams-Murphy Monica, Gisondi Michael A, Clemency Brian, Doshi Ankur A, Siegel Mari, Kraemer Mary S, Aberger Kate, Harman Stephanie, Ahuja Neera, Carlson Jestin N, Milliron Melody L, Hart Kristopher K, Gilbertson Chelsey D, Wilson Jason W, Mueller Larissa, Brown Lori, Gordon Bradley D

机构信息

From the *UPMC Hamot, Erie, Pennsylvania; †Allegheny General Hospital/Allegheny Health Network, Pittsburgh, Pennsylvania; ‡Stanford University School of Medicine, Stanford, California; §University of Minnesota Center for Bioethics, Mitchell Hamline School of Law, Minneapolis, Minnesota; ∥Northwestern University Feinberg School of Medicine, Chicago, Illinois; ¶Caring Advocates, Carlsbad, California; **Michigan State University College of Osteopathic Medicine, Knoxville, Tennessee; ††University of Alabama at Birmingham Huntsville Campus and Huntsville Hospital, Birmingham, Alabama; ‡‡State University of New York at Buffalo, Buffalo, New York; §§University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; ∥∥Temple University School of Medicine, Philadelphia, Pennsylvania; ¶¶St. Joseph's Regional Medical Center, New York Medical College, Paterson, New Jersey; ***Saint Vincent Health System/Allegheny Health Network, Erie, Pennsylvania; †††INTEGRIS Southwest Medical Center, Oklahoma State University Center for Health Sciences, Oklahoma City, Oklahoma; ‡‡‡University of South Florida, Tampa, Florida; and §§§University of Minnesota Medical School, Minneapolis, Minnesota.

出版信息

J Patient Saf. 2017 Jun;13(2):51-61. doi: 10.1097/PTS.0000000000000357.

DOI:10.1097/PTS.0000000000000357

PMID:28198722

Abstract

OBJECTIVE

End-of-life interventions should be predicated on consensus understanding of patient wishes. Written documents are not always understood; adding a video testimonial/message (VM) might improve clarity. Goals of this study were to (1) determine baseline rates of consensus in assigning code status and resuscitation decisions in critically ill scenarios and (2) determine whether adding a VM increases consensus.

METHODS

We randomly assigned 2 web-based survey links to 1366 faculty and resident physicians at institutions with graduate medical education programs in emergency medicine, family practice, and internal medicine. Each survey asked for code status interpretation of stand-alone Physician Orders for Life-Sustaining Treatment (POLST) and living will (LW) documents in 9 scenarios. Respondents assigned code status and resuscitation decisions to each scenario. For 1 of 2 surveys, a VM was included to help clarify patient wishes.

RESULTS

Response rate was 54%, and most were male emergency physicians who lacked formal advanced planning document interpretation training. Consensus was not achievable for stand-alone POLST or LW documents (68%-78% noted "DNR"). Two of 9 scenarios attained consensus for code status (97%-98% responses) and treatment decisions (96%-99%). Adding a VM significantly changed code status responses by 9% to 62% (P ≤ 0.026) in 7 of 9 scenarios with 4 achieving consensus. Resuscitation responses changed by 7% to 57% (P ≤ 0.005) with 4 of 9 achieving consensus with VMs.

CONCLUSIONS

For most scenarios, consensus was not attained for code status and resuscitation decisions with stand-alone LW and POLST documents. Adding VMs produced significant impacts toward achieving interpretive consensus.

摘要

目的

临终干预应以对患者意愿的共识性理解为依据。书面文件并非总能被理解；添加视频证词/信息（VM）可能会提高清晰度。本研究的目的是：（1）确定在危重症情况下分配代码状态和复苏决策时的基线共识率；（2）确定添加VM是否会增加共识。

方法

我们将两个基于网络的调查链接随机分配给1366名在急诊医学、家庭医学和内科设有研究生医学教育项目的机构中的教职员工和住院医师。每个调查要求对9种情况下的独立的维持生命治疗医师医嘱（POLST）和生前预嘱（LW）文件进行代码状态解读。受访者为每种情况分配代码状态和复苏决策。在两项调查中的一项中，包含了一个VM以帮助阐明患者意愿。

结果

回复率为54%，大多数是缺乏正式的高级规划文件解读培训的男性急诊医师。对于独立的POLST或LW文件，无法达成共识（68%-78%表示“不要复苏”）。9种情况中有两种在代码状态（97%-98%的回复）和治疗决策（96%-99%）方面达成了共识。在9种情况中的7种中，添加VM使代码状态回复有显著变化，变化幅度为9%至62%（P≤0.026），其中4种达成了共识。复苏回复变化幅度为7%至57%（P≤0.005），9种情况中有4种在有VM的情况下达成了共识。