葡萄牙预先指示——违背无效原则？一项横断面研究。

Portuguese Advance Directives-a twist against futility? A cross sectional study.

机构信息

MD, MSc. Physician, Serviço de Medicina Paliativa do Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal; PhD student, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.

PhD. Cathedratic Professor, Departamento de Medicina da Comunidade, Informação e Decisão em Saúde Faculdade de Medicina, Universidade do Porto, Porto, Portugal.

出版信息

Sao Paulo Med J. 2024 Mar 25;142(3):e2022537. doi: 10.1590/1516-3180.2022.0537.R2.201023. eCollection 2024.

DOI:10.1590/1516-3180.2022.0537.R2.201023

PMID:38536997

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10962926/

Abstract

BACKGROUND

Advance Directive documents allow citizens to choose the treatments they want for end-of-life care without considering therapeutic futility.

OBJECTIVES

To analyze patients' and caregivers' answers to Advance Directives and understand their expectations regarding their decisions.

DESIGN AND SETTING

This study analyzed participants' answers to a previously published trial, conceived to test the document's efficacy as a communication tool.

METHODS

Sixty palliative patients and 60 caregivers (n = 120) registered their preferences in the Advance Directive document and expressed their expectations regarding whether to receive the chosen treatments.

RESULTS

In the patient and caregiver groups, 30% and 23.3% wanted to receive cardiorespiratory resuscitation; 23.3% and 25% wanted to receive artificial organ support; and 40% and 35% chose to receive artificial feeding and hydration, respectively. The participants ignored the concept of therapeutic futility and expected to receive invasive treatments. The concept of therapeutic futility should be addressed and discussed with both the patients and caregivers. Legal Advanced Directive documents should be made clear to reduce misinterpretations and potential legal conflicts.

CONCLUSION

The authors suggest that all citizens should be clarified regarding the futility concept before filling out the Advance Directives and propose a grammatical change in the document, replacing the phrase "Health Care to Receive / Not to Receive" with the sentence "Health Care to Accept / Refuse" so that patients cannot demand treatments, but instead accept or refuse the proposed therapeutic plans.

TRIAL REGISTRATION

ClinicalTrials.gov ID NCT05090072.

URL

https://clinicaltrials.gov/ct2/show/NCT05090072.

摘要

背景

预立医疗指示文件允许公民在不考虑治疗无效的情况下选择他们希望接受的临终关怀治疗。

目的

分析患者和护理人员对预立医疗指示的回答，了解他们对决策的期望。

设计和设置

本研究分析了参与者对先前发表的一项试验的回答，该试验旨在测试该文件作为沟通工具的功效。

方法

60 名姑息治疗患者和 60 名护理人员（n=120）在预立医疗指示文件中登记了他们的偏好，并表达了他们对接受所选治疗的期望。

结果

在患者和护理人员组中，30%和 23.3%希望接受心肺复苏；23.3%和 25%希望接受人工器官支持；40%和 35%分别选择接受人工喂养和补液。参与者忽略了治疗无效的概念，并期望接受侵入性治疗。应该与患者和护理人员讨论并探讨治疗无效的概念。应向所有公民澄清预立医疗指示文件的法律概念，以减少误解和潜在的法律冲突。