Anstey Mhr, Watts N, Orford N, Seppelt I M, Mitchell I
Intensivist, Intensive Care Unit, Sir Charles Gairdner Hospital, Adjunct Researcher, Curtin University School of Public Health, Perth, Western Australia.
Post Doctoral Research Fellow, Critical Care and Trauma Division, The George Institute for Global Health, Sydney, New South Wales.
Anaesth Intensive Care. 2017 Jul;45(4):466-468. doi: 10.1177/0310057X1704500409.
Patients who come to the intensive care unit are amongst the sickest patients in our hospitals. Patients can be admitted to the intensive care unit unexpectedly (following accidents or sudden onset of illness) or as unplanned but not necessarily truly 'unexpected' admissions. These patients often have significant underlying chronic health issues, including metastatic cancer, advanced cardiac, respiratory, renal, or hepatic failure, or frailty, with a high likelihood of death in the ensuing months. Using the Australian and New Zealand Intensive Care Society Clinical Trials Group Point Prevalence Program, a prospective single-day observational study across 46 Australian hospitals in 2014 and 2015, we found that less than 9% of intensive care unit patients (51/577) had an advance directive available. From these results, we provide two suggestions to increase intensive care's understanding of patients' end-of-life wishes. First, systematically target 'high risk of dying' patient groups for goals of care conversations in the outpatient setting. Such groups include those where one would not be 'surprised' if they died within a year. Second, as a society, more conversations about end-of-life wishes are needed.
入住重症监护病房的患者是我们医院中病情最严重的患者群体。患者可能会意外入住重症监护病房（如遭遇事故或疾病突然发作后），或者属于计划外但不一定是真正“意外”的入院情况。这些患者往往存在严重的潜在慢性健康问题，包括转移性癌症、晚期心脏、呼吸、肾脏或肝脏衰竭，或身体虚弱，在接下来的几个月内死亡可能性很高。利用澳大利亚和新西兰重症监护协会临床试验组的点患病率项目，这是一项在2014年和2015年对澳大利亚46家医院进行的前瞻性单日观察性研究，我们发现不到9%的重症监护病房患者（51/577）有预先指示。基于这些结果，我们提出两条建议，以增进重症监护领域对患者临终意愿的理解。首先，在门诊环境中，系统地针对“死亡高风险”患者群体进行关于治疗目标的沟通。这类群体包括那些如果在一年内死亡人们不会感到“惊讶”的患者。其次，作为一个社会整体，需要更多关于临终意愿的交流。
