Nephrology and Computer Services, Parc Taulí University Hospital, Parc Taulí, Sabadell (Barcelona), Spain and Sanitary Corporation.
Parc Taulí University Hospital, Parc Taulí, Sabadell (Barcelona), Spain.
Nephrol Dial Transplant. 2017 Oct 1;32(10):1676-1682. doi: 10.1093/ndt/gfx245.
As renal replacement therapy has become universal practice in medicine, there is a need to consider whether this treatment is suitable for elderly people. These patients have high comorbidity and may require dialysis withdrawal in certain clinical circumstances. Advance directives (ADs) drawn up by patients facilitate treatment-related decisions if they lose cognitive capacity. Questionnaires dealing with possible extreme clinical circumstances can thus help clinicians and relatives reach pertinent decisions in such cases.
We studied the usefulness of questionnaires on ADs in patients who started periodic haemodialysis over a period of 10 years. Telephone interviews were conducted to assess satisfaction level among relatives/representatives of deceased patients who had been advised to limit therapeutic efforts in certain clinical situations. The questionnaire was assessed using a six-factor degree of satisfaction.
Four hundred and forty-three questionnaires were distributed over a period of 10 years. A total of 41.3% of patients stated that they wished to limit therapeutic efforts in the serious clinical situations presented; 37.9% refused to complete the questionnaire; 14.7% expressed their wishes without any written confirmation; and 6.1% expressed their wish to continue on dialysis in all situations. Two hundred and twenty-four patients had died by the study end date. The cause of death in 20.2% was scheduled dialysis withdrawal. Representatives reported an extremely high degree of satisfaction with the questionnaire (94.7%). Younger people, however, were more reluctant to consider and answer questionnaires on ADs.
Questionnaires on ADs are a useful tool in daily nephrology practice and should be distributed to those patients willing to consider the limitation of therapeutic efforts in extreme clinical circumstances. In general terms, these questionnaires should be given to all elderly patients.
随着肾脏替代疗法在医学中得到广泛应用，有必要考虑这种治疗方法是否适用于老年人。这些患者合并症较多，在某些临床情况下可能需要停止透析。如果患者丧失认知能力，患者预先制定的医疗指示（AD）有助于做出与治疗相关的决策。因此，针对可能出现的极端临床情况制定问卷，可以帮助临床医生和家属在这种情况下做出相关决策。
我们研究了在过去 10 年期间开始接受定期血液透析的患者的 AD 问卷的有用性。通过电话访谈评估了在某些临床情况下建议限制治疗努力的已故患者的亲属/代表对该问卷的满意度。使用六因素满意度评分来评估问卷。
在过去 10 年期间共发放了 443 份问卷。共有 41.3%的患者表示希望在呈现的严重临床情况下限制治疗努力；37.9%的患者拒绝填写问卷；14.7%的患者表示希望限制治疗，但没有书面确认；6.1%的患者表示希望在所有情况下继续进行透析。研究结束时共有 224 名患者死亡。20.2%的死亡原因为计划透析停止。代表们对问卷表示出极高的满意度（94.7%）。然而，年轻人更不愿意考虑和回答 AD 问卷。
AD 问卷是日常肾病学实践中的有用工具，应分发给那些愿意考虑在极端临床情况下限制治疗努力的患者。一般来说，应该向所有老年患者提供这些问卷。
