预先医疗指示制度与临终医疗资源利用——基于RCT研究的文献综述

被引：7

作者：

刘跃华 ^{[1
]}

戴伟 ^{[2
]}

杨燕绥 ^{[1
,3
]}

机构：

[1] 清华大学公共管理学院

[2] 湖北省人力资源和社会保障厅医疗保险管理局

[3] 清华大学深圳研究生院医院管理研究院

来源：

社会保障研究 | 2016年 / 06期

基金：

中国博士后科学基金;

关键词：

预先医疗指示; 生前遗嘱; 临终照顾计划; 临床随机对照试验;

D O I：

暂无

中图分类号：

R197.1 [医疗服务制度];

学科分类号：

摘要：

本研究纳入2000-2016年国际公开发表的针对临终患者的预先医疗指示(AD)制度设计的临床随机对照研究(RCTs),对ADs的临床产出及医疗资源利用情况评估文献进行系统综述,以期为我国实施终末期患者制定预设临终照顾计划(ACP)提供决策依据及路径。结果显示,鼓励临终患者及代理人就ACP进行主动沟通、签署AD,不仅可缓解患者焦虑、抑郁情绪,使患者临终意愿得到尊重,减少医疗纠纷,而且可显著减少患者临终期对住院、ICU等医疗资源的使用,减少激进治疗方案的选择,提高医疗资源利用效率并节省费用。

引用

页码：94 / 102

页数：9

共 21 条

[1] Advance care planning in advanced cancer: Can it be achieved? An exploratory randomized patient preference trial of a care planning discussion[J] . Louise Jones,Jane Harrington,Cate A Barlow,Adrian Tookman,Robyn Drake,Kelly Barnes,Michael King. &nbspPalliative and Supportive Care . 2011 (1)
[2] Systematic implementation of an advance directive program in nursing homes: a randomized controlled trial. Molloy D W,Guyatt G H,Russo R,Goeree R,O’Brien B J,Bédard M,Willan A,Watson J,Patterson C,Harrison C,Standish T,Strang D,Darzins P J,Smith S,Dubois S. JAMA : the journal of the American Medical Association . 2000
[3] A Nurse Practitioner Directed Intervention Improves the Quality of Life of Patients with Metastatic Cancer: Results of a Randomized Pilot Study. Stephen Dyar,Mary Lesperance,Robert Shannon. JOURNAL OF PALLIATIVE MEDICINE . 2012
[4] Advance directives and outcomes of surrogate decision making before death. Silveira Maria J,Kim Scott Y H,Langa Kenneth M. The New England Quarterly . 2010
[5] Effect of a Disease-Specific Advance Care Planning Intervention on End-of-Life Care. Karin T. Kirchhoff,Bernard J. Hammes,Karen A. Kehl. JOURNAL OF THE AMERICAN GERIATRICS SOCIETY . 2012
[6] A randomized trial to improve communication about end-of-life care among patients with COPD. David H Au,Edmunds M Udris,Ruth A Engelberg. Chest . 2012
[7] The effect of discussions about advance directives on patients’ satisfaction with primary care[J] . William M. Tierney,Paul R. Dexter,Gregory P. Gramelspacher,Anthony J. Perkins,Xiao-Hua Zhou,Fredric D. Wolinsky. &nbspJournal of General Internal Medicine . 2001 (1)
[8] A prospective study of the efficacy of the physician order form for life-sustaining treatment
Tolle, SW
Tilden, VP
Nelson, CA
Dunn, PM
[J]. JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 1998, 46 (09) : 1097 - 1102
[9] The impact of advance care planning on end of life care in elderly patients:randomised controlled trial. Detering,K.M.et al. British Medical Journal . 2010
[10] CM/Rec,C.o.E.R 11 of the Committee of Ministers to member states on principles concerning continuing powers of attorney and advance directives for incapacity. https://wcd.coe.int/View Doc.jsp?id=1563397&Site=CM . 2009

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