The Cheryl Spencer Department of Nursing, University of Haifa, Israel; Rambam Health Care Campus, Haifa, Israel.
The Cheryl Spencer Department of Nursing, University of Haifa, Israel; Rambam Health Care Campus, Haifa, Israel.
Am J Emerg Med. 2019 Jun;37(6):1020-1024. doi: 10.1016/j.ajem.2018.08.036. Epub 2018 Aug 13.
This study explored the therapeutic approaches used for end-of-life (EOL) patients admitted to the emergency department (ED) and examined whether the decision to perform life-extending treatment (LET) or to allow natural death (AND) depends on patient characteristics, medical staff variables, and ED setting.
A retrospective archive study was conducted from January 2015 to December 2017 in the ED of a tertiary hospital. The study sample were 674 EOL patients who had died in the ED. For each patient, data were collected and measured for dying process (LET vs. AND), patient characteristics, ED-setting variables, and medical-staff characteristics.
The proportion of EOL patients undergoing LET increased from 18.1% in 2015 to 25.9% in 2016 and to 30.3% in 2017 (p = .010), and a quarter of them were treated by emergency medical services. Males tended to receive LET more than females (p < .001). An association was found between Jewish physicians and nurses and AND (p = .001). Heavier workload in the ED and greater severity of the triage classification predicted more LET (OR-1.67, CI = 1.05-1.76, p = .003 and OR = 1.42, CI-0.60-0.81, p < .001, respectively). Receiver operating characteristic analysis showed that patient characteristics contributed most crucially to the therapeutic approaches (C statistic 0.624-0.675, CI-0.62-0.71).
The therapeutic approach used for EOL patients in the ED depends on variables in all three treatment layers: patient, medical staff, and ED setting. Applicable national programs should be developed to ensure that no external factors influence the dying-process decision.
本研究探讨了因生命末期（EOL）而入住急诊科（ED）的患者所采用的治疗方法，并考察了决定是否采取延长生命的治疗（LET）或允许自然死亡（AND）的因素，包括患者特征、医护人员变量以及 ED 环境。
本回顾性档案研究于 2015 年 1 月至 2017 年 12 月在一家三级医院的 ED 进行。研究样本为在 ED 死亡的 674 名 EOL 患者。为每位患者收集并测量了死亡过程（LET 与 AND）、患者特征、ED 环境变量和医护人员特征的数据。
2015 年接受 LET 的 EOL 患者比例为 18.1%，2016 年增至 25.9%，2017 年增至 30.3%（p=0.010），其中四分之一的患者由急救医疗服务部门治疗。男性比女性更倾向于接受 LET（p<0.001）。发现犹太裔医生和护士与 AND 相关（p=0.001）。ED 工作负荷较大和分诊分类较严重预示着 LET 较多（OR-1.67，CI=1.05-1.76，p=0.003 和 OR=1.42，CI-0.60-0.81，p<0.001）。受试者工作特征分析显示，患者特征对治疗方法的影响最为关键（C 统计值 0.624-0.675，CI-0.62-0.71）。
ED 中 EOL 患者的治疗方法取决于三个治疗层面的变量：患者、医护人员和 ED 环境。应制定适用的国家方案，以确保临终决策不受任何外部因素影响。
