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在代码状态文档中描述医生建议:一个多中心队列研究和定性话语分析.

Rochelle G Melvin1, Jacqueline M Kruser2, Saeha Shin3

  • 1Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada. rochelle.melvin@nygh.on.ca.

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概括

在心肺复苏 (CPR) 讨论期间,医生经常建议不要进行侵入性治疗. 然而,他们经常未能记录患者的目标,这表明在代码状态讨论中需要改进沟通和文档实践.

关键词:
代码状态讨论 代码状态讨论人们的生活质量.治疗建议 治疗建议

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科学领域:

  • 医学伦理 医学伦理
  • 老年医学 老年医学
  • 卫生沟通健康沟通

背景情况:

  • 关于患者对心肺复苏 (CPR) 治疗偏好的讨论是住院成人的标准.
  • 这些代码状态讨论旨在使患者的护理与他们的价值观和优先事项保持一致.
  • 在这些关键的对话中,医生建议的程度仍然不清楚.

研究的目的:

  • 在代码状态讨论期间,描述医生治疗建议的性质和程度.
  • 专注于老年住院医疗患者 (75岁及以上).

主要方法:

  • 对200名75岁以上的患者进行了回顾性队列研究,这些患者被录取到加拿大多伦多的一家通用医疗服务中心.
  • 医疗记录的定性话语分析,记录代码状态讨论.
  • 专注于医生治疗建议及其记录的理由.

主要成果:

  • 大多数医生建议有利于缓和或避免侵入性治疗.
  • 医生的角色从提供建议到积极保留干预的范围.
  • 理性诊断经常引用不良预后或解释患者的目标,但如何确定目标的记录很少.
  • "生活质量"一词有时被用来暗示治疗方法没有益处.

结论:

  • 医生在代码状态讨论期间提出建议的做法有很大的不同.
  • 一个常见的缺陷是缺乏记录的患者目标和优先事项,支持治疗建议.
  • 在代码状态讨论中,有一个明显的机会来增强医生如何制定,沟通和记录建议.