Bedell S E, Delbanco T L
N Engl J Med. 1984 Apr 26;310(17):1089-93. doi: 10.1056/NEJM198404263101706.
We studied the extent to which 82 private physicians and 75 house officers talked with hospitalized patients or their families (or both) about whether they would desire cardiopulmonary resuscitation if it became necessary. During the period of study (1981), 154 patients were resuscitated at our university teaching hospital. In 68 per cent of the cases, physicians had formed an opinion about the patient's attitude toward cardiopulmonary resuscitation. However, only 30 (19 per cent) of the patients had discussed resuscitation before the arrest with either their private physician or a house officer (or both); 51 (33 per cent) of the families were consulted. These percentages did not differ significantly according to the underlying disease, whether the patient was on the general wards or in the intensive-care unit, the physician's estimate of the probability of arrest, or the physician's level of training. Even the 151 physicians who believed that patients should participate in decisions about resuscitation, actually discussed the issue with their patients only rarely. We interviewed the 24 competent patients who survived cardiopulmonary resuscitation, to compare their actual attitudes about resuscitation with their physicians' opinions about their attitudes. The physician's opinion about a patient's desire for resuscitation correlated only weakly with the preference expressed by the patient. We suggest that physicians and patients consider the benefit of open discussion about cardiopulmonary resuscitation.
我们研究了82名私人医生和75名住院医生与住院患者或其家属（或两者）就患者在必要时是否希望进行心肺复苏进行交谈的程度。在研究期间（1981年），我校教学医院有154名患者接受了复苏。在68%的病例中，医生已就患者对心肺复苏的态度形成了看法。然而，只有30名（19%）患者在心跳骤停前与他们的私人医生或住院医生（或两者）讨论过复苏问题；51名（33%）患者的家属被咨询过。这些百分比在潜在疾病、患者是在普通病房还是重症监护病房、医生对心跳骤停可能性的估计或医生的培训水平方面没有显著差异。即使是151名认为患者应该参与复苏决策的医生，实际上也很少与他们的患者讨论这个问题。我们采访了24名在心肺复苏后存活下来的有行为能力的患者，以比较他们对复苏的实际态度与医生对他们态度的看法。医生对患者复苏意愿（的看法）与患者表达的偏好之间的关联很弱。我们建议医生和患者考虑就心肺复苏进行公开讨论的益处。
