严重病入院患者的目标一致护理与治疗限制在POLST:混合方法研究
Kelly C Vranas1,2,3, Ritika Singh2, Jenna L Shenk4
1Center to Improve Veteran Involvement in Care, VA Portland Health Care System (VAPORHCS), Portland, Oregon, USA.
Journal of the American Geriatrics Society
|July 15, 2025
概括
严重病患有有限的治疗偏好有时会接受高强度护理,与他们的目标保持一致. 了解临床医生的心态和护理背景对于将终身护理与患者愿望相协调至关重要.
科学领域:
- 医学伦理 医学伦理
- 抚慰性护理是一种缓解性护理.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 维持生命治疗的医生订单 (POLST) 记录了患者对严重疾病的护理偏好.
- 波尔斯特不一致的护理,即治疗与记录的偏好相矛盾,是常见的,但不太了解.
- 调查POLST不一致护理的背景对于将终身护理与患者目标相协调至关重要.
研究的目的:
- 检查重病患者的POLST异调护理的背景.
- 要确定POLST不一致的护理是否代表目标不一致的护理.
- 为调整终身护理与患者偏好的策略提供信息.
主要方法:
- 对接受高强度治疗的POLST限制患者电子病历的回顾性图表审查.
- 纳入标准:有限治疗/安慰措施的POLST,提交给ED,接受高强度治疗.
- 医院住院文档的诱导性/演性内容分析,以确定决策主题.
主要成果:
- 32名患有POLST限制的患者接受了与POLST不一致的护理,主要是癌症,脑血管疾病或心力衰竭.
- 大多数患者 (94%) 患有急性手术诊断,接受手术,输管 (75%) 或ICU入院 (44%).
- 关键主题:POLST不一致的护理可以符合目标;临床医生"修复它"的心态;对预后的不完全理解;POLST实施中的挑战.
结论:
- 严重病患者的POLST不一致的护理,尽管进行高强度治疗,但可以符合目标.
- 临床医生的心态,沟通和对临床轨迹的理解对治疗决策产生重大影响.
- 在急性情形下,对预先护理计划文件的有效解释仍然是一个挑战.
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