用于限制潜在不有益的延长生命的干预措施的决策方法
Jason N Batten1, Sofia Weiss Goitiandia2, Julia K Axelrod2
1Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, Los Angeles.
JAMA network open
|February 20, 2026
概括
临床医生面临的挑战是使用推的共享决策或机构流程限制非有益的延长生命的治疗. 有些人使用政策不支持的替代方法,导致实践变化和道德问题.
科学领域:
- 医学伦理 医学伦理
- 临床决策 - 临床决策
- 卫生政策 卫生政策
背景情况:
- 专业指南建议共享决策或制度流程,以限制非有益的延长生命的干预措施.
- 医疗保健系统经常默认延长寿命,从而对临床医生的实践产生不确定性.
研究的目的:
- 描述临床医生使用的决策方法,以限制可能无益的延长生命的干预措施.
- 确定临床医生是否依赖于推或替代方法.
主要方法:
- 定性研究涉及3个学术医疗中心的101名临床医生 (医生,护士,牧师,社会工作者) 的深入,半结构化访谈.
- 在2018年2月至2022年6月期间进行的采访.
- 分析开发了一个框架,将方法分类为推或替代.
主要成果:
- 确定了六种决策方法:知情选择,建议,说明计划,不提供,不提及干预措施,并援引冲突的机构流程.
- 临床医生报告了建议方法 (共享决策,机构流程) 的挑战.
- 使用了替代方法,但报告了临床间/医院间的变化和伦理不确定性.
结论:
- 临床医生在实施推的策略以限制非有益的延长生命的干预措施时遇到重大挑战.
- 一些临床医生采取了与专业政策声明不一致的替代方法,突出了政策和实践之间的差距.
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