Miller A, Lo B
West J Med. 1985 Aug;143(2):256-8.
Although patient preferences are important in decisions about "do not resuscitate" (DNR) orders, little is known about how physicians discuss these orders with patients. We asked 15 physicians to simulate discussing such orders with a patient. We found a striking variation in whether physicians explicitly asked for patient preferences, how they described cardiopulmonary resuscitation (CPR) and its possible outcomes and whether they made a recommendation to the patient about DNR orders. There was no pattern to the different amounts of information presented about CPR. Physicians gave conflicting reasons for how they individualized discussions with patients. Awareness of such different behaviors may stimulate physicians to examine what they say to patients about this sensitive and important topic and why they say it.
尽管患者的偏好对于“不要复苏”（DNR）医嘱的决策很重要，但对于医生如何与患者讨论这些医嘱却知之甚少。我们让15名医生模拟与患者讨论此类医嘱。我们发现，医生是否明确询问患者的偏好、如何描述心肺复苏（CPR）及其可能的结果，以及他们是否就DNR医嘱向患者提出建议，存在显著差异。关于CPR所提供的不同信息量没有规律。医生们对于如何针对患者进行个性化讨论给出了相互矛盾的理由。意识到这种不同的行为可能会促使医生审视他们在这个敏感而重要的话题上对患者说了什么以及为什么这么说。
