导航在马来西亚的急诊室的不尝试复苏决策:一项回顾性研究
K S Chew1, H T M Kho2, X Y Yang3
1Universiti Malaysia Sarawak, Faculty of Medicine and Health Sciences, Kota Samarahan, Sarawak, Malaysia. kschew@unimas.my.
The Medical journal of Malaysia
|October 1, 2024
概括
马来西亚的不尝试复苏 (DNAR) 决策主要由重症患者的代理决策者做出,并有限地使用预先指示. 这突显了文化挑战,以及需要改善医疗保健机构的生命终端沟通.
科学领域:
- 医学伦理 医学伦理
- 临床实践 临床实践
- 卫生政策 卫生政策
背景情况:
- 不尝试复苏 (DNAR) 命令尊重患者的自主权,并解决医疗徒劳问题.
- 包括马来西亚在内的亚洲国家对DNAR实践的研究有限.
- 这项研究调查了马来西亚一家三级医院的DNAR决策过程.
研究的目的:
- 探索"不尝试复苏" (DNAR) 决策的细微差别.
- 为了确定影响马来西亚第三级医院DNAR订单的关键因素.
- 了解文化背景在终身护理讨论中的作用.
主要方法:
- 在急诊和创伤部门进行了一项混合方法的回顾性研究.
- 通过使用监控表格和主题分析分析了115起DNAR案件.
- 数据包括患者人口统计学,DNAR类型,原因,代孕药物和结果.
主要成果:
- 患者的平均年龄为71.32岁,男性占主导地位.
- 主要的DNAR原因包括危急疾病 (33.9%) 和具有脆弱性的晚年 (20.9%).
- 成年儿童 (63.5%) 是最常见的代孕决策者,提前指示很少.
结论:
- 马来西亚的DNAR决策往往是由重症患者的代孕者做出的,受文化规范影响,反对讨论死亡.
- 成年儿童经常充当代孕,面临复杂的决策.
- 加强沟通和决策支持对于终身护理的急诊部门至关重要.
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