这个病人有医疗决策能力吗?
Laura L Sessums1, Hanna Zembrzuska, Jeffrey L Jackson
1Section of General Internal Medicine, Walter Reed Army Medical Center, 6900 Georgia Ave NW, Washington, DC 20307, USA. laura.sessums@us.army.mil
JAMA
|July 28, 2011
概括
医疗决策能力低下在住院患者中很常见,但临床医生往往没有认识到这一点. 建议使用能力评估辅助 (ACE) 帮助医生准确评估患者的能力.
科学领域:
- 老年医学 老年医学
- 医学伦理 医学伦理
- 临床心理学 临床心理学
背景情况:
- 评估患者做出医疗决策的能力至关重要,尤其是在怀疑失能时.
- 评估应具体针对当前的医疗决定.
研究的目的:
- 确定在没有严重精神疾病的成年医学患者中失能的流行率.
- 评估临床医生对失能评估的准确性.
主要方法:
- 对前性研究的系统审查 (n=43) 评估医疗决策能力的工具.
- 从MEDLINE和EMBASE数据库开始到2011年4月进行搜索.
- 由两位作者独立提取数据和进行质量评估.
主要成果:
- 在健康老年人对照组中,残疾患病率为2.8%,而在药物住院患者中为26%.
- 临床医生仅在42%的受影响患者中承认失能,尽管诊断准确 (LR + 7.9).
- 援助能力评估 (ACE) 显示出强大的诊断特征 (LR+ 8.5,LR- 0.21),并且可以免费获得.
结论:
- 患者无法做出医疗决策是普遍存在的,并且经常被忽视.
- 迷你心理状态考试 (MMSE) 只有在极端分数时才有用,用于评估能力.
- ACE是帮助医生进行能力评估的最合适的工具.
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