透析患者希望按照他们的预先指令有多严格?
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
概括
患者希望在预先指示中获得灵活性. 许多透析患者更喜欢医生和代孕产妇,以便在最重要的治疗决策中发挥作用,以符合他们最佳利益.
科学领域:
- 生物伦理学生物伦理学
- 医疗法 法律 医疗法
- 患者的自主权患者的自主权
背景情况:
- 克鲁桑案和患者自决法促进了维持生命治疗的预先指令.
- 严格遵守预先指示可能并不总是符合患者的最佳利益.
- 患者对预先指示灵活性的偏好需要进一步调查.
研究的目的:
- 为了确定患者在严格遵循预先指示的变化.
- 探索患者对医生和代孕妇在推翻预先指示的自由裁量权的偏好.
- 为了确定患者在终身治疗决策中认为重要的因素.
主要方法:
- 在七个门诊慢性透析中心进行的采访研究.
- 一百五十个有精神能力的透析患者参加了这次活动.
- 一个结构化的问卷调查评估了愿意允许推翻预先指示和考虑因素的意愿.
主要成果:
- 在给予超越的余地方面,患者存在显著的差异:39%的患者"没有余地",19%的患者"有点余地",11%的患者"有很大的余地",31%的患者"完全有余地".
- 患者对影响决策的因素表达了不同的偏好,包括疼痛,生活质量,新疗法,羞辱,财务影响和宗教信仰.
- 预先指示的遵守偏好在患者中不均.
结论:
- 严格遵守所有预先指示可能并不反映患者真正的偏好.
- 医生应该明确地与患者讨论预先指示的所需严格性.
- 将患者指定的因素纳入决策过程可以提高预先指示的有用性.
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