随机对照试验对有高死亡风险的住院患者心肺复苏决策支持干预。
Randomized Controlled Trial of a Decision Support Intervention About Cardiopulmonary Resuscitation for Hospitalized Patients Who Have a High Risk of Death.
机构信息
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.
出版信息
J Gen Intern Med. 2021 Sep;36(9):2593-2600. doi: 10.1007/s11606-021-06605-y. Epub 2021 Feb 2.
BACKGROUND
Many seriously ill hospitalized patients have cardiopulmonary resuscitation (CPR) as part of their care plan, but CPR is unlikely to achieve the goals of many seriously ill hospitalized patients.
OBJECTIVE
To determine if a multicomponent decision support intervention changes documented orders for CPR in the medical record, compared to usual care.
DESIGN
Open-label randomized controlled trial.
PATIENTS
Patients on internal medicine and neurology wards at two tertiary care teaching hospitals who had a 1-year mortality greater than 10% as predicted with a validated model and whose care plan included CPR, if needed.
INTERVENTION
Both the control and intervention groups received usual communication about CPR at the discretion of their care team. The intervention group participated in a values clarification exercise and watched a CPR video decision aid.
MAIN MEASURE
The primary outcome was the proportion of patients who had a no-CPR order at 14 days after enrollment.
KEY RESULTS
We recruited 200 patients between October 2017 and October 2018. Mean age was 77 years. There was no difference between the groups in no-CPR orders 14 days after enrollment (17/100 (17%) intervention vs 17/99 (17%) control, risk difference, - 0.2%) (95% confidence interval - 11 to 10%; p = 0.98). In addition, there were no differences between groups in decisional conflict summary score or satisfaction with decision-making. Patients in the intervention group had less conflict about understanding treatment options (decisional conflict knowledge subscale score mean (SD), 17.5 (26.5) intervention arm vs 40.4 (38.1) control; scale range 0-100 with lower scores reflecting less conflict).
CONCLUSIONS
Among seriously ill hospitalized patients who had CPR as part of their care plan, this decision support intervention did not increase the likelihood of no-CPR orders compared to usual care.
PRIMARY FUNDING SOURCE
Canadian Frailty Network, The Ottawa Hospital Academic Medical Organization.
背景
许多重病住院患者的治疗计划中都包括心肺复苏（CPR），但 CPR 不太可能实现许多重病住院患者的治疗目标。
目的
确定多组分决策支持干预是否与常规护理相比，改变病历中 CPR 的记录医嘱。
设计
开放性标签随机对照试验。
患者
在两家三级教学医院的内科和神经科病房住院的患者，根据经过验证的模型预测，这些患者在 1 年内的死亡率超过 10%，并且他们的治疗计划包括如有需要进行心肺复苏术。
干预措施
对照组和干预组都根据治疗团队的判断接受了关于心肺复苏术的常规沟通。干预组参加了一次价值观澄清练习，并观看了心肺复苏术视频决策辅助。
主要测量指标
主要结局是在入组后 14 天内无 CPR 医嘱的患者比例。
主要结果
我们于 2017 年 10 月至 2018 年 10 月期间招募了 200 名患者。平均年龄为 77 岁。入组后 14 天，两组之间无 CPR 医嘱的比例无差异（干预组 100 例中有 17 例[17%]，对照组 99 例中有 17 例[17%]，风险差异为-0.2%（95%置信区间为-11 至 10%；p=0.98）。此外，两组在决策冲突综合评分或决策满意度方面均无差异。干预组患者对治疗选择的理解冲突较小（决策冲突知识亚量表评分均值（标准差），干预组为 17.5（26.5），对照组为 40.4（38.1）；量表范围为 0-100，得分越低表示冲突越小）。
结论
在将 CPR 作为治疗计划一部分的重病住院患者中，与常规护理相比，该决策支持干预并不能增加无 CPR 医嘱的可能性。
主要资金来源
加拿大虚弱网络、渥太华医院学术医疗组织。
Zotero 插件