患者对代码状态讨论的偏好:信息与随机试验. 以患者价值为中心的框架
Christopher Joshi1, Sehrish Malik2, Wei Wang3,4
1Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA. cjoshi@bidmc.harvard.edu.
Journal of general internal medicine
|December 11, 2024
概括
患者更喜欢以价值为中心的方法进行心肺复苏 (CPR) 讨论,感觉更容易被听取和理解. 大多数患者希望临床医生根据他们的个人价值观提出建议.
科学领域:
- 医学伦理 医学伦理
- 患者的自主权患者的自主权
- 临床交流 临床沟通
背景情况:
- 尊重患者在医院的自主权,涉及到代码状态讨论.
- 在了解患者对这些决策框架的偏好方面存在差距.
研究的目的:
- 在心肺复苏 (CPR) 讨论中,以信息为中心和以患者价值为中心的框架之间比较患者被听到和理解的感觉.
- 为了确定患者对CPR讨论框架的偏好.
主要方法:
- 一项前性随机研究比较了两个CPR讨论框架.
- 患有严重疾病的成年患者被随机分配到以信息为中心或以患者价值为中心的框架中.
- 患者报告的"听到和理解"评级是主要的结果指标.
主要成果:
- 与以信息为中心的框架相比,患者在以患者价值为中心的框架中感觉"被听到和理解"的程度要高得多 (p=0.033).
- 89%的受试者希望获得有关心肺复苏的个性化临床医生建议 (p<0.001).
结论:
- 患者在很大程度上倾向于以患者价值为中心的CPR讨论框架.
- 支持基于患者价值的临床医生建议,与息治疗专家的共识保持一致.
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