患者对手术前代码状态讨论的观点:定性分析
Shanze Tahir1, Jocelyn Streid2, Matthew B Allen2
1Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA.
Journal of pain and symptom management
|February 12, 2026
概括
老年手术患者经常误解他们的复苏偏好,尽管他们意识到这一点. 改善沟通需要解决系统障碍,培养对以患者为中心的护理的信任.
科学领域:
- 医学伦理 医学伦理
- 手术患者护理手术患者护理
- 卫生沟通 卫生沟通
背景情况:
- 专业指导方针强调了术前代码状态沟通对于有复苏限制的患者.
- 几乎没有人知道手术患者如何看待这些讨论,他们有"不复苏" (DNR) /"不输管" (DNI) 或"维持生命治疗医疗命令" (MOLST) 命令.
研究的目的:
- 了解患者对外科手术期间关于代码状态的沟通的看法.
- 找出改善与患者价值观协调护理的方法.
主要方法:
- 与12名65岁以上的手术患者进行了半结构面试,这些患者有记录的治疗限制指令.
- 采访探讨了对代码状态的理解,之前的讨论,对未来对话的期望和偏好.
- 使用了一种混合的演-诱导定性内容分析.
主要成果:
- 75%的患者知道他们对复苏的偏好,但<50%的人回忆起手术前的讨论.
- 75%的人在EMR文档和个人对代码状态的理解之间出现了不一致.
- 关键主题包括冲突,系统层面的失望,有限的理解和来自共享决策的信任. 障碍:时间压力,分散的护理,不清晰的文件.
结论:
- 治疗限制指令的老年手术患者在术后代码状态讨论中面临沟通缺口和系统障碍.
- 患者需要信任,连续性和反思时间来支持以患者为中心的护理.
- 这些发现可以帮助改善严重疾病的沟通和术后护理.
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