透析患者は,その事前の指示をどの程度厳格に遵守したいのか?
A Sehgal1, A Galbraith, M Chesney
1Department of Veterans Affairs, Robert Wood Johnson Clinical Scholars Program, University of California, San Francisco 94143.
JAMA
|January 1, 1992
まとめ
患者は,前もって指示する際に柔軟性を求めています. 多くの透析患者は,医師や代理人に対して,自分の最善の利益のために治療決定を優先する余裕を持つことを好みます.
科学分野:
- バイオエシック バイオエシック
- 医療法 医療法 医療法について
- 患者の自律性は,患者の自律性です.
背景:
- クルーザン事件と患者自決法は,生命維持治療の事前指示を推進しています.
- 事前指示の厳格な遵守は,常に患者の最善の利益と一致しない場合があります.
- 事前指示の柔軟性に関する患者の好みは,さらなる調査を必要としています.
研究 の 目的:
- 予備指示の厳格な遵守に関する患者さまの変動を判断する.
- 予備指示を優先する際に医師と代理母による裁量に関する患者の好みを調査する.
- 患者の生命の終わりの治療決定において重要なと考えられる要因を特定する.
主な方法:
- 7つの外来慢性透析センターで実施されたインタビュー研究.
- 150人の精神的に有能な透析患者さんが参加しました.
- 構造化されたアンケートでは,事前指示の無効化を認める意思と考慮された要因を評価した.
主要な成果:
- 39%が"余裕がない",19%が"少し余裕がある"""%が"多くの余裕がある"31%が"完全に余裕がある"と回答した.
- 患者は,痛み,生活の質,新しい治療法,屈辱感,経済的影響,宗教的な信念など,意思決定に影響を与える要因に対するさまざまな好みを表現しました.
- 事前指示の遵守の好みは,患者によって均一ではない.
結論:
- すべての事前指示を厳格に遵守することは,患者の真の好みを反映していない可能性があります.
- 医師は,事前指示の厳しさについて,患者と明示的に話し合うべきです.
- 意思決定に患者特別の要因を組み込むことは,事前指示の有用性を向上させることができます.
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