抽象
目的:确定呼吸学专家何时接触终末期慢性阻塞性肺疾病(COPD)患者,以决定机械通气的使用、他们向患者提供什么信息以及如何提供这些信息。设计:自我管理的全国调查。与会者:所有加拿大呼吸医学专家;在401名符合资格的呼吸科医生中,有279名(69.6%)填写了问卷。结果测量:关于机械通气的医患讨论的时间和内容;医生对他们参与决策过程的程度的感知;以及可能影响决策的患者和医生的特征。结果:讨论据报道最常发生在COPD的晚期:当患者呼吸困难严重(235[84.2%]的受访者报告)或当患者第一秒用力呼气量为30%或低于预测值(210[75.3%])时。120名受访者(43.0%)表示,他们与40%或更少的COPD患者讨论机械通气,然后病情加重需要通气支持。大多数(154[55.2%])将决策过程描述为患者和医生之间的协作; 83 (29.7%) reported that the patient decides after he or she has considered the physician's opinion. Over half (148 [53.0%]) of the respondents indicated that they occasionally, often or always modify the information provided to patients in order to influence their decision about mechanical ventilation. CONCLUSIONS: Discussions with COPD patients concerning end-of-life decisions about mechanical ventilation are reported to occur in advanced stages of the disease or not at all, with patients' input where possible. Information presented to patients is often modified in order to influence the decision. Future studies should explore ways to involve patients further in the decision-making process and to improve the process for both patients and physicians.
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