Department of Palliative Medicine, University of California, Irvine, California, USA.
Department of Emergency Medicine, University of California, Irvine, California, USA.
J Pain Symptom Manage. 2017 Nov;54(5):654-660.e1. doi: 10.1016/j.jpainsymman.2017.07.038. Epub 2017 Jul 25.
Emergency physicians (EPs) often need to make a decision whether or not to intubate a terminal cancer patient.
The objective of this study was to explore EPs' attitudes about intubating critically ill, terminal cancer patients.
Fifty EPs at three emergency departments (one university based, one community, and one Health Maintenance Organization) in Southern California participated in an anonymous survey that presented a hypothetical case of an end-stage lung cancer patient in pending respiratory failure. Fourteen questions along a five-point Likert scale asked EPs about prognosis and factors that influence their decision to intubate or not.
A convenience sampling of 50 EPs yielded a 100% survey response rate. Ninety-four percent believed intubation would not provide an overall survival benefit. If the family insisted, 26% would intubate the patient even with a do-not-intubate (DNI) status. Ninety-four percent would postpone intubation if palliative consultation were available in the ED. Sixty-eight percent believed that a discussion about goals of care was more time consuming than intubation. Only 16% believed they had sufficient training in palliative care. Although 29% who felt they had inadequate palliative care training would intubate the patient with a DNI, only 13% of EPs with self-perceived adequate palliative care training would intubate that patient.
EPs vary in their attitudes about intubating dying cancer patients when families demanded it, even when they believed it was nonbeneficial and against the patient's wishes. Palliative care education has the potential to influence that decision making. Intubation could be mitigated by the availability of palliative consultation in the ED.
急诊医师（EP）经常需要决定是否对终末期癌症患者进行插管。
本研究旨在探讨 EP 对危重症终末期癌症患者进行插管的态度。
南加州三家急诊部（一家大学附属，一家社区，一家医疗保健组织）的 50 名 EP 参与了一项匿名调查，该调查提出了一种终末期肺癌患者即将发生呼吸衰竭的假设病例。14 个问题沿着五点李克特量表，询问 EP 关于预后和影响他们插管或不拔管决定的因素。
对 50 名 EP 的便利抽样得出了 100%的调查响应率。94%的人认为插管不会提供总体生存获益。如果家属坚持，即使患者有“不要插管”（DNI）状态，也有 26%的 EP 会插管。如果在 ED 有姑息治疗咨询，94%的 EP 会推迟插管。68%的人认为讨论治疗目标比插管花费的时间更多。只有 16%的人认为他们在姑息治疗方面有足够的培训。尽管 29%的人认为他们在姑息治疗方面的培训不足，但他们会对有 DNI 的患者进行插管，只有 13%的自我认为姑息治疗培训充足的 EP 会对该患者进行插管。
当家属要求时，EP 对临终癌症患者插管的态度存在差异，即使他们认为这对患者无益且违背患者意愿。姑息治疗教育有可能影响这一决策。ED 中姑息治疗咨询的可用性可能会减轻插管的可能性。
