在代码状态讨论中共享决策的随机试验
Christoph Becker1,2, Sebastian Gross1, Katharina Beck1
1Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.
NEJM evidence
|April 22, 2025
概括
共享决策显著增加了选择不复苏 (DNR) 状态的患者,并减少了决策不确定性. 这种方法改善了患者对结果的理解,以及他们对终身护理的偏好.
科学领域:
- 医学伦理 医学伦理
- 以患者为中心的护理
- 临床决策 - 临床决策
背景情况:
- 共享决策对患者代码状态偏好的影响尚不清楚.
- 现有的护理模式可能无法充分支持患者对复苏的知情选择.
- 评估新的方法对于加强终身护理讨论至关重要.
研究的目的:
- 为了比较一个共享的决策方法与通常的护理患者代码状态讨论.
- 评估共享决策对患者做不复苏 (DNR) 偏好的影响.
- 评估对决策质量的影响,特别是决策不确定性.
主要方法:
- 一个实用的集群随机对照试验,涉及206名住院人员和2663名医疗患者,遍及瑞士6家教学医院.
- 干预组接受了培训,检查清单和决策辅助,以便共享决策;对照组接受了通常的照顾.
- 主要终点:患者选择DNR状态. 二级终点:通过决策冲突量表来确定决策不确定性.
主要成果:
- 分享决策组的患者更有可能选择DNR状态 (50.0%对37.2%;调整后的RR,1.37).
- 干预组报告的决策不确定性显著降低 (决策冲突量表上14.4比21.8分).
- 该方法在统计学上显著地影响了代码状态偏好和决策质量.
结论:
- 共享决策,包括讨论预期结果,显著影响医疗患者的代码状态偏好.
- 这种方法导致人们更倾向于做不复苏的状态,并与减少决策不确定性有关.
- 这些发现支持将结构化共享决策纳入终身护理计划.
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