Department of public health and primary care, Leiden University Medical Center, Postal adres: V06-P, Postbus 9600, 2300 RC, Leiden, The Netherlands.
Novicare, Laan van Vredenoord 33, 2289 DA, Rijswijk, The Netherlands.
BMC Geriatr. 2018 Jan 25;18(1):25. doi: 10.1186/s12877-018-0707-5.
In health care for older adults, patients with multimorbidity usually receive the same interventions as those patients without multimorbidity. However, standard curative or life-sustaining treatment options have to be considered carefully in view of the maximally attainable result in older and frail patients. To guide such complex medical decisions, we present a compact deliberation framework that could assist physician(s) in charge of the medical treatment of a specific elderly patient to systematize his own thinking about treatment and decisional responsibilities, in case of an intercurrent disease.The framework includes four questions to be addressed when deciding on a single urgent standard curative or life-sustaining intervention in acute medical problems of an elderly patient with multimorbidity: 1) What is known about the patient's aims and preferences? 2) Will the intervention be effective? 3) Will the intervention support the aims and preferences of the patient? 4) In view of the aims and preferences, will the risks and benefits be in balance?If all four considerations are answered favorably, the intervention will fit patient-centered and appropriate care for frail older patients with multimorbidity.Application to a patient case illustrates how our framework can improve the quality of the shared decision-making process in care for older people and helps clarify medical and moral considerations regarding how to appropriately treat the individual patient.
在老年人的医疗保健中，患有多种疾病的患者通常接受与无多种疾病的患者相同的干预措施。然而，对于年老体弱的患者，必须考虑最大限度地实现可达到的结果，仔细考虑标准的治疗或维持生命的治疗方案。为了指导这种复杂的医疗决策，我们提出了一个紧凑的审议框架，该框架可以帮助负责特定老年患者医疗治疗的医生系统地思考自己的治疗和决策责任，以防发生急性疾病。该框架包括在患有多种疾病的老年患者的急性医疗问题中决定单一紧急标准治疗或维持生命的干预措施时需要解决的四个问题：1）患者的目标和偏好是什么？2）干预是否有效？3）干预是否支持患者的目标和偏好？4）考虑到目标和偏好，风险和收益是否平衡？如果所有四个考虑都得到了肯定的回答，那么干预将符合以患者为中心的、对患有多种疾病的体弱老年人的适当护理。通过一个患者案例的应用，说明了我们的框架如何提高老年人护理中共同决策过程的质量，并有助于澄清有关如何适当治疗个体患者的医疗和道德考虑因素。
