Krumholz H M, Phillips R S, Hamel M B, Teno J M, Bellamy P, Broste S K, Califf R M, Vidaillet H, Davis R B, Muhlbaier L H, Connors A F, Lynn J, Goldman L
Department of Medicine, Yale School of Medicine and the Yale-New Haven Hospital Center for Outcomes Research and Evaluation, Conn 06520-8025, USA.
Circulation. 1998 Aug 18;98(7):648-55. doi: 10.1161/01.cir.98.7.648.
We sought to describe the resuscitation preferences of patients hospitalized with an exacerbation of severe congestive heart failure, perceptions of those preferences by their physicians, and the stability of the preferences.
Of 936 patients in this study, 215 (23%) explicitly stated that they did not want to be resuscitated. Significant correlates of not wanting to be resuscitated included older age, perception of a worse prognosis, poorer functional status, and higher income. The physician's perception of the patient's preference disagreed with the patient's actual preference in 24% of the cases overall. Only 25% of the patients reported discussing resuscitation preferences with their physician, but discussion of preferences was not significantly associated with higher agreement between the patient and physician. Of the 600 patients who responded to the resuscitation question again 2 months later, 19% had changed their preferences, including 14% of those who initially wanted resuscitation (69 of 480) and 40% of those who initially did not (48 of 120). The physician's perception of the patient's hospital resuscitation preference was correct for 84% of patients who had a stable preference and 68% of those who did not.
Almost one quarter of patients hospitalized with severe heart failure expressed a preference not to be resuscitated. The physician's perception of the patient's preference was not accurate in about one quarter of the cases. but communication was not associated with greater agreement between the patient and the physician. A substantial proportion of patients who did not want to be resuscitated changed their minds within 2 months of discharge.
我们试图描述因严重充血性心力衰竭加重而住院的患者的复苏偏好、医生对这些偏好的认知以及偏好的稳定性。
在本研究的936名患者中，215名（23%）明确表示他们不想接受复苏。不想接受复苏的显著相关因素包括年龄较大、预后较差的认知、功能状态较差和收入较高。总体而言，在24%的病例中，医生对患者偏好的认知与患者的实际偏好不一致。只有25%的患者报告与医生讨论过复苏偏好，但偏好的讨论与患者和医生之间更高的一致性并无显著关联。在2个月后再次回答复苏问题的600名患者中，19%改变了他们的偏好，其中包括最初想要复苏的患者中的14%（480名中的69名）和最初不想要复苏的患者中的40%（120名中的48名）。对于偏好稳定的患者，医生对其住院复苏偏好的认知正确率为84%，对于偏好不稳定的患者，这一正确率为68%。
近四分之一因严重心力衰竭住院的患者表示不想接受复苏。在约四分之一的病例中，医生对患者偏好的认知不准确，但沟通与患者和医生之间更高的一致性并无关联。相当一部分不想接受复苏的患者在出院后2个月内改变了主意。
