D'Halluin Pauline, Sautenet Bénédicte, François Maud, Birmelé Béatrice
Service de néphrologie-hémodialyse, centre hospitalier de la Côte Basque, 13, avenue de l'interne J. Loeb, 64100 Bayonne, France.
Service de néphrologie et immunologie clinique, CHRU de Bretonneau, 2, boulevard Tonnellé, 37044 Tours, France.
Nephrol Ther. 2020 Jul;16(4):191-196. doi: 10.1016/j.nephro.2019.12.004. Epub 2020 Jun 27.
Respect of patient's autonomy is essential. So that patients are able to write their advance directives in case of a situation where they are unable to make decisions for themselves. Currently, few people have written advance directives. We studied the feasibility of a systematic implementation of advance directives in haemodialysis patients. This prospective, single-center study was conducted in an ambulatory hemodialysis center. There were 4 steps: caregivers survey about advance directives; selection of patients and information about advance directives; writing advance directives with the interested patients; and finally, non-participation causes assessment of the other informed patients. Caregivers are not comfortable with advance directives, and have reluctances: the patient's lack of medical knowledge; the anxiety generated by end-of-life talk. Fifty-six patients (51.6%) were included and received the information. Nine of them wanted to write their advance directives on a suitable form. Eight finalised them (7.4% of the initial population). The majority wanted a therapeutic limitation. Twenty-nine patients, who have received the information about advance directives, didn't want to write them, the main reason was that they felt healthy or that they thought that their relatives would take the right decisions. Eighteen patients left the centre during the study. The development of advance directives requires information and training of caregivers and patient support. Few patients went to the end of the process. The limit of the patient's ability to decide for himself is difficult to define. The role of the doctor is central to accompany the patient during this process.
尊重患者的自主权至关重要。这样患者就能在无法自行做决定的情况下写下他们的预立医疗指示。目前，很少有人写下预立医疗指示。我们研究了在血液透析患者中系统实施预立医疗指示的可行性。这项前瞻性单中心研究在一个门诊血液透析中心进行。有4个步骤：对护理人员进行关于预立医疗指示的调查；挑选患者并提供有关预立医疗指示的信息；与感兴趣的患者一起撰写预立医疗指示；最后，对其他已获信息但未参与的患者评估未参与的原因。护理人员对预立医疗指示不太放心，存在顾虑：患者缺乏医学知识；临终谈话引发的焦虑。56名患者（51.6%）被纳入并获得了相关信息。其中9人想用合适的表格写下他们的预立医疗指示。8人最终完成了（占初始人群的7.4%）。大多数人希望进行治疗限制。29名已获得预立医疗指示相关信息的患者不想写，主要原因是他们感觉自己健康，或者认为他们的亲属会做出正确决定。18名患者在研究期间离开了该中心。预立医疗指示的制定需要对护理人员进行信息和培训以及患者支持。很少有患者走完整个流程。患者自行做决定的能力界限难以界定。医生在这个过程中陪伴患者的作用至关重要。
