Suppr超能文献

如果患者丧失行为能力,他们希望家人还是医生做出治疗决策?原因何在?

Do Patients Want their Families or their Doctors to Make Treatment Decisions in the Event of Incapacity, and Why?

作者信息

Wendler David, Wesley Robert, Pavlick Mark, Rid Annette

机构信息

Department of Bioethics, NIH Clinical Center.

Biostatistics and Clinical Epidemiology, NIH Clinical Center.

出版信息

AJOB Empir Bioeth. 2016;7(4):251-259. doi: 10.1080/23294515.2016.1182235. Epub 2016 Apr 26.

Abstract

BACKGROUND

Current practice relies on patient-designated and next-of-kin surrogates, in consultation with clinicians, to make treatment decisions for patients who lose the ability to make their own decisions. Yet, there is a paucity of data on whether this approach is consistent with patients' preferences regarding who they want to make treatment decisions for them in the event of decisional incapacity.

METHODS

Self-administered survey of patients at a tertiary care center.

RESULTS

Overall, 1169 respondents completed the survey (response rate=59.8%). Of the 229 respondents who had previously designated a surrogate, 78.2% wanted their surrogate to make treatment decisions in the event of decisional incapacity, whereas 21.8% wanted their doctors to make treatment decisions. Of the 822 respondents who had not designated a surrogate, 66.1% wanted their family to make treatment decisions, whereas 33.9% wanted their doctors to make treatment decisions. The most common explanation provided for why respondents wanted their surrogate or family to make treatment decisions for them in the event of decisional incapacity was the belief that loved ones knew the patient's treatment preferences.

CONCLUSIONS

Contrary to current practice, 33.9% of respondents who had not designated a surrogate, and 21.8% of those who had designated a surrogate indicated that they wanted their doctors to make treatment decisions for them in the event of decisional incapacity. Moreover, many of those who wanted their surrogates or family members to make treatment decisions explained this preference by citing a belief that loved ones knew the patient's treatment preferences. This belief is undermined by prior research which suggests that surrogates and family members frequently are unable to predict which treatments their charges would want. Future research should assess these two concerns with current practice and, where necessary, identify approaches to address them.

摘要

背景

目前的做法是依靠患者指定的代理人及近亲代理人,在与临床医生协商后,为失去自主决策能力的患者做出治疗决策。然而,关于这种方法是否符合患者在决策能力丧失时希望谁为其做出治疗决策的偏好,相关数据却很匮乏。

方法

对一家三级医疗中心的患者进行自我管理式调查。

结果

总体而言,1169名受访者完成了调查(回复率=59.8%)。在229名之前指定了代理人的受访者中,78.2%希望其代理人在决策能力丧失时做出治疗决策,而21.8%希望其医生做出治疗决策。在822名未指定代理人的受访者中,66.1%希望其家人做出治疗决策,而33.9%希望其医生做出治疗决策。对于受访者为何希望其代理人或家人在决策能力丧失时为他们做出治疗决策,最常见的解释是相信亲人了解患者的治疗偏好。

结论

与当前做法相反,33.9%未指定代理人的受访者以及21.8%已指定代理人的受访者表示,他们希望医生在决策能力丧失时为他们做出治疗决策。此外,许多希望其代理人或家庭成员做出治疗决策的人解释这种偏好的原因是相信亲人了解患者的治疗偏好。但先前的研究对这一观点提出了质疑,该研究表明代理人和家庭成员常常无法预测其委托人会希望接受哪些治疗。未来的研究应评估当前做法中的这两个问题,并在必要时确定解决这些问题的方法。

相似文献

1
Do Patients Want their Families or their Doctors to Make Treatment Decisions in the Event of Incapacity, and Why?
AJOB Empir Bioeth. 2016;7(4):251-259. doi: 10.1080/23294515.2016.1182235. Epub 2016 Apr 26.
2
Systematic review: Individuals' goals for surrogate decision-making.
J Am Geriatr Soc. 2012 May;60(5):884-95. doi: 10.1111/j.1532-5415.2012.03937.x. Epub 2012 Apr 3.
3
Patients' Priorities for Surrogate Decision-Making: Possible Influence of Misinformed Beliefs.
AJOB Empir Bioeth. 2022 Jul-Sep;13(3):137-151. doi: 10.1080/23294515.2021.1983665. Epub 2021 Oct 1.
4
Patient and surrogate disagreement in end-of-life decisions: can surrogates accurately predict patients' preferences?
Med Decis Making. 2008 Jul-Aug;28(4):524-31. doi: 10.1177/0272989X08315244. Epub 2008 Jun 19.
5
Surrogates' predictions of seriously ill patients' resuscitation preferences.
Arch Fam Med. 1995 Jun;4(6):518-23. doi: 10.1001/archfami.4.6.518.
6
The accuracy of surrogate decision makers: a systematic review.
Arch Intern Med. 2006 Mar 13;166(5):493-7. doi: 10.1001/archinte.166.5.493.
8
Patients' priorities for treatment decision making during periods of incapacity: quantitative survey.
Palliat Support Care. 2015 Oct;13(5):1165-83. doi: 10.1017/S1478951514001096. Epub 2014 Oct 2.
9
Surviving surrogate decision-making: what helps and hampers the experience of making medical decisions for others.
J Gen Intern Med. 2007 Sep;22(9):1274-9. doi: 10.1007/s11606-007-0252-y. Epub 2007 Jul 7.
10
Improving advance care planning by accommodating family preferences.
J Palliat Med. 2001 Winter;4(4):481-9. doi: 10.1089/109662101753381629.

引用本文的文献

2
Incorporating Patient Values in Large Language Model Recommendations for Surrogate and Proxy Decisions.
Crit Care Explor. 2024 Aug 12;6(8):e1131. doi: 10.1097/CCE.0000000000001131. eCollection 2024 Aug 1.
3
Artificial Intelligence and Decision-Making in Healthcare: A Thematic Analysis of a Systematic Review of Reviews.
Health Serv Res Manag Epidemiol. 2024 Mar 5;11:23333928241234863. doi: 10.1177/23333928241234863. eCollection 2024 Jan-Dec.
4
The Advance Care Compass- A New Mechanics for Digitally Transforming Advance Directives.
Front Digit Health. 2021 Oct 15;3:753747. doi: 10.3389/fdgth.2021.753747. eCollection 2021.

本文引用的文献

1
Scope and outcomes of surrogate decision making among hospitalized older adults.
JAMA Intern Med. 2014 Mar;174(3):370-7. doi: 10.1001/jamainternmed.2013.13315.
3
Systematic review: Individuals' goals for surrogate decision-making.
J Am Geriatr Soc. 2012 May;60(5):884-95. doi: 10.1111/j.1532-5415.2012.03937.x. Epub 2012 Apr 3.
4
Systematic review: the effect on surrogates of making treatment decisions for others.
Ann Intern Med. 2011 Mar 1;154(5):336-46. doi: 10.7326/0003-4819-154-5-201103010-00008.
5
Advance directives and outcomes of surrogate decision making before death.
N Engl J Med. 2010 Apr 1;362(13):1211-8. doi: 10.1056/NEJMsa0907901.
8
The accuracy of surrogate decision makers: a systematic review.
Arch Intern Med. 2006 Mar 13;166(5):493-7. doi: 10.1001/archinte.166.5.493.
9
Not all patients want to participate in decision making. A national study of public preferences.
J Gen Intern Med. 2005 Jun;20(6):531-5. doi: 10.1111/j.1525-1497.2005.04101.x.
10
Micromanaging death: process preferences, values, and goals in end-of-life medical decision making.
Gerontologist. 2005 Feb;45(1):107-17. doi: 10.1093/geront/45.1.107.

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验