Garrett J M, Harris R P, Norburn J K, Patrick D L, Danis M
Sheps Center for Health Services Research, University of North Carolina, Chapel Hill 27599-7490.
J Gen Intern Med. 1993 Jul;8(7):361-8. doi: 10.1007/BF02600073.
To determine patient characteristics associated with the desire for life-sustaining treatments in the event of terminal illness.
In-person survey from October 1986 to June 1988.
13 internal medicine and family practices in North Carolina.
2,536 patients (46% of those eligible) aged 65 years and older who were continuing care patients of participating practices, enrolled in Medicare. The patients were slightly older than the 65+ general population, 61% female, and 69% white, and most had one or more chronic illnesses.
The authors asked the patients whether they would want each of six different treatments (hospitalization, intensive care, cardiopulmonary resuscitation, surgery, artificial ventilation, or tube feeding) if they were to have a terminal illness. The authors combined responses into three categories ranging from the desire for more treatment to the desire for less treatment. After adjustment for other factors, 53% of women chose less treatment compared with 43% of men; 35% of blacks vs 15% of whites and 23% of the less well educated vs 15% of the better educated expressed the desire for more treatment. High depression scores also were associated with the desire for more treatment (26% for depressed vs 18% for others).
Patients' choices for care in the event of terminal illness relate to an intricate set of demographic, educational, and cultural factors. These results should not be used as a shortcut to determine patient preferences for care, but may provide new insights into the basis for patients' preferences. In discussing choices for future life-sustaining care, physicians need to explore with each individual the basis for his or her choices.
确定与绝症患者维持生命治疗意愿相关的患者特征。
1986年10月至1988年6月进行的面对面调查。
北卡罗来纳州的13家内科和家庭医疗诊所。
2536名65岁及以上的患者（占符合条件者的46%），他们是参与诊所的持续护理患者，参加了医疗保险。这些患者比65岁以上的普通人群稍年长，61%为女性，69%为白人，且大多数患有一种或多种慢性病。
作者询问患者，如果他们身患绝症，是否希望接受六种不同治疗中的每一种（住院治疗、重症监护、心肺复苏、手术、人工通气或鼻饲）。作者将回答合并为三类，范围从希望接受更多治疗到希望接受更少治疗。在对其他因素进行调整后，53%的女性选择接受更少治疗，而男性为43%；35%的黑人与15%的白人、23%受教育程度较低者与15%受教育程度较高者表示希望接受更多治疗。高抑郁评分也与希望接受更多治疗相关（抑郁者为26%，其他人则为18%）。
绝症患者的护理选择与一系列复杂的人口统计学、教育和文化因素相关。这些结果不应被用作确定患者护理偏好的捷径，但可能为患者偏好的依据提供新的见解。在讨论未来维持生命护理的选择时，医生需要与每位患者探讨其选择的依据。
