O'Brien L A, Grisso J A, Maislin G, LaPann K, Krotki K P, Greco P J, Siegert E A, Evans L K
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia 19104-6095, USA.
JAMA. 1995 Dec 13;274(22):1775-9.
To determine life-sustaining treatment preferences among nursing home residents, whether information regarding cardiopulmonary resuscitation (CPR) affected these preferences, and with whom treatment preferences had been discussed, and to identify factors associated with CPR preferences.
In-person survey.
Forty-nine randomly selected nursing homes.
Four hundred twenty-one randomly selected nursing home residents capable of making decisions.
Preferences regarding CPR, hospitalization, and enteral tube feedings, and individual factors associated with CPR preferences.
Of 1458 randomly selected nursing home residents assessed for the ability to participate in the study, 552 residents (38%) were eligible to participate and 421 agreed to be interviewed. Sixty percent of participants able to participate in the decision reported that they would elect CPR, 89% would choose hospitalization if seriously ill, and 33% would elect enteral tube feedings if no longer able to eat because of permanent brain damage. Individual factors associated with preferences for CPR included the following: African-American ethnicity, high self-reported physical mobility, belief that most important medical care decisions should be made by the doctor, moderate-to-severe impairment in daily decision-making skills, and not having a spouse. Fourteen percent changed their preference from preferring CPR to not preferring CPR after receiving additional information about CPR procedures. Twelve percent reported having discussed preferences with health care providers, and 31% discussed preferences with family members.
More than half of nursing home residents capable of making decisions preferred the use of CPR. Few had discussed their preferences with health care providers. Individual preferences should be assessed when considering the use of life-sustaining treatments.
确定疗养院居民对维持生命治疗的偏好，关于心肺复苏（CPR）的信息是否会影响这些偏好，以及他们与谁讨论过治疗偏好，并确定与CPR偏好相关的因素。
面对面调查。
随机选择的49家疗养院。
随机选择的421名有决策能力的疗养院居民。
对CPR、住院治疗和肠内管饲的偏好，以及与CPR偏好相关的个体因素。
在随机评估参与研究能力的1458名疗养院居民中，552名居民（38%）符合参与条件，421名同意接受访谈。60%有决策能力的参与者表示他们会选择CPR，89%表示如果身患重病会选择住院治疗，33%表示如果因永久性脑损伤而无法进食会选择肠内管饲。与CPR偏好相关的个体因素包括：非裔美国人种族、自我报告的身体活动能力较高、认为最重要的医疗决策应由医生做出、日常决策能力有中度至重度损害以及没有配偶。14%的人在收到关于CPR程序的更多信息后，将他们对CPR的偏好从倾向变为不倾向。12%的人报告曾与医疗服务提供者讨论过偏好，31%的人曾与家庭成员讨论过偏好。
超过一半有决策能力的疗养院居民倾向于使用CPR。很少有人与医疗服务提供者讨论过他们的偏好。在考虑使用维持生命的治疗时，应评估个体偏好。
