调整患者值和代码状态:选择语法效应 (CODE) 研究
Karthik J Kota1, Catherine Chen1, Renu George1
1Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Journal of the American Geriatrics Society
|March 5, 2024
概括
使用"允许自然死亡"而不是"不复苏" (DNR) 并没有改变老年住院患者的复苏决定. 这两句话都导致了关于代码状态的简短而令人满意的讨论.
科学领域:
- 医学伦理 医学伦理
- 老年医学 老年医学
- 抚慰性护理是一种缓解性护理.
背景情况:
- 复苏决策对于患者的满意度,结果和医疗保健成本至关重要.
- 医生在讨论终身护理时面临障碍,包括主题不适和时间限制.
- 特定语言对复苏讨论的影响仍未得到充分探索.
研究的目的:
- 调查使用"允许自然死亡"作为"不复苏" (DNR) 的替代品是否会影响住院患者的代码状态决策.
- 为了比较两个短语组之间的患者满意度和讨论时间.
主要方法:
- 102名65岁以上的英语患者被录取到通用医学教学服务中,被随机选择.
- 参与者参与了复苏讨论,使用"不要复苏" (DNR) 或"允许自然死亡"的措辞.
- 测量结果包括复苏决定,对话满意度和持续时间,以及与疾病严重程度的相关性.
主要成果:
- 总体"没有代码"率为16.7% (13%的DNR与20.4%的"允许自然死亡"),群体之间没有显著差异 (p=0.35).
- 讨论时间 (3.9分钟与4.9分钟) 和患者满意度 (>90%在两个手臂) 类似,但没有显著差异.
- 之前报告的代码状态讨论的障碍没有遇到.
结论:
- 与DNR讨论相比",允许自然死亡"的措辞并没有改变"没有代码"率.
- 代码状态讨论很简短,对患者来说非常令人满意,无论使用什么术语.
- 查代码状态适用于所有住院患者,无论使用哪种特定语言.
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