Bates D W, Tolle S W, Elliot D L
West J Med. 1988 Apr;148(4):471-3.
Cardiac deaths are more likely to be unanticipated than cancer deaths by patients, their families, and their physicians. We hypothesized that differing physician attitudes toward dying patients may affect the degree of expectation of death. To evaluate differences in attitudes and behaviors among subspecialists, we surveyed a randomly selected population of California subspecialists; 44 of 136 (32%) of cardiologists and 91 of 167 (55%) of oncologists responded. Oncologists experienced three times as many deaths as cardiologists and reported having discussed code status more often with patients who died. Cardiologists' patients' deaths were more often unexpected and occurred more frequently in intensive care units. In addition, their patients were more likely to be given cardiopulmonary resuscitation. Oncologists reported being more comfortable dealing with dying patients and having less desire to avoid them. When presented with patient scenarios, however, cardiologists' and oncologists' responses were similar when discussing and estimating prognosis and likelihood of successful therapy.
与癌症死亡相比，心脏疾病导致的死亡更不容易被患者、其家人以及医生所预料到。我们推测，医生对濒死患者的不同态度可能会影响对死亡的预期程度。为了评估不同亚专科医生在态度和行为上的差异，我们对加利福尼亚州的亚专科医生进行了随机抽样调查；136名心脏病专家中有44名（32%）回复，167名肿瘤学家中有91名（55%）回复。肿瘤学家经历的死亡病例数量是心脏病专家的三倍，且报告称与死亡患者讨论抢救状态的频率更高。心脏病专家的患者死亡往往更出人意料，且更多发生在重症监护病房。此外，他们的患者接受心肺复苏的可能性更大。肿瘤学家表示在处理濒死患者时更自在，且不太想避开他们。然而，当面对患者情况时，心脏病专家和肿瘤学家在讨论和评估预后以及成功治疗的可能性时的反应相似。
