对病重患者心肺复苏知情同意讨论的调查演变。
Evolution of Investigating Informed Assent Discussions about CPR in Seriously Ill Patients.
机构信息
Pulmonary and Critical Medicine, HSRF 222 (R.D.S), University of Vermont Larner College of Medicine, Burlington, Vermont, USA.
Division Director and Professor, Pulmonary, Critical Care, and Sleep Medicine, CSB 816, MSC 630 (D.W.F.), Medical University of South Carolina, Charleston, South Carolina, USA.
出版信息
J Pain Symptom Manage. 2022 Jun;63(6):e621-e632. doi: 10.1016/j.jpainsymman.2022.03.009.
CONTEXT
Outcomes after cardiopulmonary resuscitation (CPR) remain poor. We have spent 10 years investigating an "informed assent" (IA) approach to discussing CPR with chronically ill patients/families. IA is a discussion framework whereby patients extremely unlikely to benefit from CPR are informed that unless they disagree, CPR will not be performed because it will not help achieve their goals, thus removing the burden of decision-making from the patient/family, while they retain an opportunity to disagree.
OBJECTIVES
Determine the acceptability and efficacy of IA discussions about CPR with older chronically ill patients/families.
METHODS
This multi-site research occurred in three stages. Stage I determined acceptability of the intervention through focus groups of patients with advanced COPD or malignancy, family members, and physicians. Stage II was an ambulatory pilot randomized controlled trial (RCT) of the IA discussion. Stage III is an ongoing phase 2 RCT of IA versus attention control in in patients with advanced chronic illness.
RESULTS
Our qualitative work found the IA approach was acceptable to most patients, families, and physicians. The pilot RCT demonstrated feasibility and showed an increase in participants in the intervention group changing from "full code" to "do not resuscitate" within two weeks after the intervention. However, Stages I and II found that IA is best suited to inpatients. Our phase 2 RCT in older hospitalized seriously ill patients is ongoing; results are pending.
CONCLUSIONS
IA is a feasible and reasonable approach to CPR discussions in selected patient populations.
背景
心肺复苏（CPR）后的结果仍然不佳。我们已经花费了 10 年时间研究一种“知情同意”（IA）方法，用于与慢性疾病患者/家属讨论 CPR。IA 是一种讨论框架，根据该框架，极不可能从 CPR 中受益的患者被告知，除非他们不同意，否则不会进行 CPR，因为这不会帮助他们实现目标，从而将决策负担从患者/家属身上卸下，同时他们保留不同意的机会。
目的
确定与老年慢性疾病患者/家属进行有关 CPR 的 IA 讨论的可接受性和效果。
方法
这项多地点研究分三个阶段进行。第一阶段通过对患有晚期 COPD 或恶性肿瘤的患者、家庭成员和医生进行焦点小组讨论，确定干预措施的可接受性。第二阶段是 IA 讨论的门诊试点随机对照试验（RCT）。第三阶段是目前正在进行的 IA 与高级慢性疾病患者的注意力对照的 2 期 RCT。
结果
我们的定性研究发现，IA 方法大多数患者、家庭和医生都能接受。试点 RCT 表明该方法具有可行性，并表明干预组中在干预后两周内从“全面复苏”转为“不复苏”的参与者人数有所增加。然而，第一和第二阶段发现，IA 最适合住院患者。我们正在对老年住院重症患者进行的 2 期 RCT 仍在进行中；结果有待公布。
结论
IA 是在选定的患者群体中进行 CPR 讨论的一种可行且合理的方法。
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