Cohen L M, McCue J D, Germain M, Woods A
Tufts University School of Medicine, Boston, Massachusetts, USA.
Psychosomatics. 1997 Jan-Feb;38(1):27-34. doi: 10.1016/S0033-3182(97)71500-7.
A structured interview was administered to a sample of patients on maintenance dialysis and their attending physicians to obtain information on the documentation of their end-of-life treatment preferences. The majority of the patients reported never having considered stopping dialysis, or having discussed with their nephrologist or family the circumstances in which treatment should be discontinued. Only 7 patients (6%) had completed an advance directive; these patients were all men (P = 0.01) and tended to be better educated (P = 0.02). Only one of the nine physicians had completed an advance directive. In most cases, the dialysis patients and their treatment team staff were preoccupied with the struggles of daily life and had avoided or denied considerations of terminal illness and death. The literature on denial, medical illness, and dying is also reviewed as it relates to dialysis patients, end-of-life treatment, and terminal care.
对一组维持性透析患者及其主治医生进行了结构化访谈，以获取有关其临终治疗偏好记录的信息。大多数患者表示从未考虑过停止透析，也从未与肾病医生或家人讨论过应在何种情况下停止治疗。只有7名患者（6%）完成了预先指示；这些患者均为男性（P = 0.01），且往往受教育程度较高（P = 0.02）。9名医生中只有1人完成了预先指示。在大多数情况下，透析患者及其治疗团队成员都忙于应对日常生活中的困难，回避或否认对绝症和死亡的思考。本文还回顾了与否认、疾病和死亡相关的文献，以及这些文献与透析患者、临终治疗和终末期护理的关系。
