Douglas Sara L, Daly Barbara J, Lipson Amy R
School of Nursing, Case Western Reserve University, USA.
Res Rev J Nurs Health Sci. 2017 Dec;3(3):74-84. Epub 2017 Nov 24.
The purpose of this study was to determine the accuracy and concordance between physicians (MDs) and family surrogate decision makers (FSDMs) in predicting 3 month post-hospital patient mortality and concordance in identifying patient goals of care. A prospective cohort study was conducted in 3 intensive care units (ICUs). Two-hundred and sixty-four FSDMs and 54 attending MDs of patients who had resided in the ICU for >3 days were enrolled in the study. Expectation for mortality was measured dichotomously and goals of care were measured using a continuous visual analog scale. A value of 50 represented equal weight placed on goals of survival and QOL. Both MDs and FSDMs had mortality predictions that were lower than actual mortality. For MDs and FSDMs, their mortality predictions were most accurate at study enrollment. Discordance between MD and FSDM goals of care ranged from 36.4% at enrollment to 55.4% 15 days later (p=0.003). Our findings of optimistic prognosis for survival are consistent with the work of others. Our high rate of discordance regarding goals of care provided support for the need to establish standard processes to assure that values of patients and families are solicited and incorporated into treatment discussions for long-stay ICU patients.
本研究的目的是确定医生（医学博士）和家庭替代决策者（FSDM）在预测患者出院后3个月死亡率方面的准确性和一致性，以及在确定患者护理目标方面的一致性。在3个重症监护病房（ICU）进行了一项前瞻性队列研究。纳入了264名FSDM和54名在ICU住院超过3天的患者的主治医生参与研究。死亡率预期采用二分法测量，护理目标采用连续视觉模拟量表测量。数值50表示对生存目标和生活质量给予同等权重。医学博士和FSDM的死亡率预测均低于实际死亡率。对于医学博士和FSDM而言，他们在研究入组时的死亡率预测最为准确。医学博士和FSDM在护理目标上的不一致率从入组时的36.4%到15天后的55.4%（p = 0.003）。我们关于生存预后乐观的研究结果与其他研究一致。我们在护理目标方面的高不一致率支持了建立标准流程的必要性，以确保征求患者和家属的意见并将其纳入长期入住ICU患者的治疗讨论中。
