慈悲の性質である. "蘇生させない"という命令を受けた患者のケア
D P Sulmasy1, G Geller, R Faden
1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
JAMA
|February 5, 1992
まとめ
倫理教育介入により,特に同時治療に関する懸念 (CCC) について,蘇生禁止令 (DNR) の患者に対するケアが改善されました. DNRの治療の質は,患者の診断によって異なっており,標的の倫理教育プログラムの必要性を強調しています.
科学分野:
- 医療倫理 医療倫理について
- クリニカル・プラクティスの改善
- 患者介護の質 患者のケアの質
背景:
- Do Not Resuscitate (DNR) 命令を取り巻く慣行は,患者の希望と包括的なケアを確保するために注意深く注意する必要があります.
- DNRの注文文書と同時治療の懸念 (CCC) の変動が観察されており,患者の特徴と医療提供者の教育と関連している可能性があります.
研究 の 目的:
- 倫理教育による介入が,DNR命令に関する医療官の慣行に与える影響を評価する.
- DNRのケア品質,患者の診断,および人口統計学的変数との関連を決定する.
主な方法:
- 都市部にある大学院の教科病院の88人の内科室職員を対象とした1年間のランダム化対照試験.
- ハウス・オフィサーは,広範な倫理介入,限られた介入,またはコントロールグループに割り当てられました.
- DNR命令の患者チャートは,出席署名,文書化された理由,同意,および11の同時ケアに関する懸念 (CCC) を含め,病院のポリシーへの遵守について検討されました.
主要な成果:
- 倫理教育グループでは,DNR注文につきCCCの数は著しく増加した (0.9~3.8),対照グループでは減少した (1.9~1.0).
- 適切な同意を含むDNRポリシーへの遵守は,他の診断または悪性腫瘍と比較して,既得免疫不全症候群 (AIDS) の患者にとって低かった.
- 患者の診断は,人口統計学的変数ではなく,DNR順序ごとにCCCの有意な予測因子でした.
結論:
- 広範な倫理教育介入は,特にCCCに関して,DNR命令を受けた患者のケア品質を向上させることができます.
- DNR患者に対する医療の質は,診断に基づく系統的な変動を示しており,医療の格差を示唆しています.
- 研究結果は,ケアの一貫性を改善するために,患者の診断を考慮して倫理教育プログラムが設計され,実施されるべきであることを示唆しています.
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