培训医生,以改善成人住院患者的伦理决策,这些患者可能接受过度治疗. 在CODE阶梯集群随机对照试验随机对照试验
Dominique D Benoit1,2, Aglaja De Pauw3, Celine Jacobs3
1Faculty of Medicine and Health Care Sciences, Ghent University, Ghent, Belgium. dominique.benoit@ugent.be.
Intensive care medicine
|September 4, 2024
概括
在道德决策方面指导医生改善了以目标为导向的护理,其证据是增加了"不要插管"和"不要尝试心肺复苏"的命令. 然而,这种干预措施并没有提高医疗保健团队内的伦理气候.
科学领域:
- 医学伦理 医学伦理
- 临床决策 - 临床决策
- 改善医疗保健质量 改善医疗保健质量
背景情况:
- 医疗保健中的道德决策对于以患者为中心的护理至关重要.
- 以目标为导向的护理,包括事先的护理计划,确保尊重患者的偏好.
- 在住院患者的潜在过度治疗 (PET) 需要明确的沟通和道德考虑.
研究的目的:
- 评估是否指导医生在道德决策方面改善了通过"不插管"和"不尝试心肺复苏" (DNI-DNACPR) 命令以目标为导向的护理.
- 评估这种指导对医疗团队道德气候质量的影响.
- 分析对可能过度治疗 (PET) 管理的影响.
主要方法:
- 一个阶梯集群随机对照试验在ICU和内部医学部门进行.
- 在干预之前和之后,医生和护士填写了伦理决策气候问卷 (EDMCQ).
- 确定可能接受过度治疗 (PET) 的患者被监测DNI-DNACPR订单.
主要成果:
- 辅导在潜在过度治疗 (PET) 患者 (29.7%对19.6%) 和总人口 (3.4%对1.9%) 中显著增加了DNI-DNACPR决策的发生率.
- 一年死亡率在总人口中干预和对照组之间没有显著差异 (14.5%与15.1%).
- 干预后的伦理决策气候问卷 (EDMCQ) 评分没有显著改善 (平均差异为0.02分).
结论:
- 在道德决策方面指导医生有效地提高了以目标为导向的护理,正如增加使用DNI-DNACPR命令所表明的那样.
- 干预措施并没有导致医疗保健专业人员感知到的伦理气候的同时改善.
- 调查结果表明,有针对性的指导可以改善预先护理规划文件,而不会对道德氛围产生负面影响.
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