在息护理咨询之前记录的家庭和临床医生的互动与创伤性脑损伤患者中维持生命治疗的撤回率较低有关
Vikas N Vattipally1, Oishika Das1, Jacob Jo1
1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
The American journal of hospice & palliative care
|December 30, 2025
概括
在创伤性脑损伤 (TBI) 患者的息护理咨询 (PCC) 之前,家庭和临床医生的沟通增加与停止维持生命治疗 (WLST) 的几率较低有关. 更多记录的相互作用可能会影响护理目标,无论临床严重程度如何.
科学领域:
- 神经科学是一个神经科学.
- 医学伦理 医学伦理
- 医疗保健服务研究 医疗服务研究
背景情况:
- 创伤性脑损伤 (TBI) 的管理经常涉及关于停止维持生命治疗 (WLST) 的困难决定.
- 息治疗咨询 (PCC) 对这些决定至关重要,但家庭-临床医生沟通对WLST结果的影响尚不清楚.
- 了解WLST的预测因素对于改善TBI患者生命终端护理至关重要.
研究的目的:
- 调查PCC之前记录的家庭和临床医生的相互作用与TBI患者中WLST的可能性之间的关联.
- 确定WLST的关键预测因素,特别关注通信模式.
- 探索家庭参与在严重TBI治疗目标讨论中的作用.
主要方法:
- 对接受神经外科咨询和PCC的TBI患者进行了回顾性队列研究.
- 在PCC作为主要暴露之前,对已记录的家庭和临床医生的相互作用进行分析.
- 多变量后勤回归和LASSO回归以确定WLST的预测因子,调整临床混因子.
主要成果:
- 在这项研究中的228名TBI患者中,超过一半 (51%) 接受了WLST.
- 在PCC之前记录的家庭和临床医生相互作用的数量较多与较低的WLST几率显著相关 (aOR=0.95,P=.02).
- 拉索回归确定了记录的家族相互作用和放射性中线转移作为WLST的独立预测因素.
结论:
- 在PCC之前增加家庭和临床医生的沟通可能与TBI患者的WLST可能性降低有关.
- 这表明,加强家庭参与可能会影响治疗目标的决策,这可能与临床严重程度无关.
- 需要进一步的前性研究来证实这些发现并探索因果关系.
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