晚期疾病的老年人急诊室的严重疾病对话:一项随机临床试验
Kei Ouchi1,2,3, Susan D Block1,3,4, Dorene M Rentz1,5
1Harvard Medical School, Boston, Massachusetts.
JAMA network open
|June 18, 2025
概括
在急诊部 (ED) 的护士主导的严重疾病对话 (SIC) 干预并没有改善患者报告的预先护理计划 (ACP) 参与,但增加了临床医生记录的SIC. 紧急救助医生可以为严重疾病的老年人提供关键的生命结束讨论.
科学领域:
- 老年学是一门学科.
- 抚慰性护理是一种缓解性护理.
- 紧急医疗 紧急医疗
背景情况:
- 严重疾病对话 (SIC) 对于以患者为中心的终身护理至关重要.
- 在急诊室 (ED) 的许多重病患者没有SIC,冒着不必要的护理的风险.
- 提前护理规划 (ACP) 的参与对于将护理与患者价值观保持一致至关重要.
研究的目的:
- 评估基于ED的多模式SIC干预 (ED GOAL) 与通常的护理.
- 评估干预对患者报告的ACP参与的影响.
- 为了确定在ED出院后对临床医生记录的SIC的影响.
主要方法:
- 一个双臂,并行设计的随机临床试验,涉及50岁以上的141名重病成年人和他们的护理人员.
- 干预包括护士主导的激励面试,结构化的SIC和沟通启动.
- 1,3,6个月测量结果包括患者报告的ACP参与和SIC的医疗记录文件.
主要成果:
- 一个月后患者报告的ACP参与没有显著差异 (3.37对3.32;P=.58).
- 在干预组中,更多患者与医生讨论护理偏好 (17.1%对7.0%;P=.07) 的趋势.
- 3个月 (24.3%对9.9%;P=.03) 和6个月 (31.4%对12.7%;P=.008) 的临床医生对生命终结价值和目标的记录显著更高.
结论:
- 基于ED的SIC干预并没有显著改善患者报告的ACP参与度.
- 这项干预措施有效地增加了临床医生记录在医疗记录中的SIC.
- 紧急服务部门是重病老年人开始SIC的关键接入点.
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