OBJECTIVE:Both physicians and patients view advance directives as important, yet discussions occur infrequently. We assessed differences and correlations between physicians' and their patients' desires for end-of-life care for themselves.

MEASUREMENTS AND MAIN RESULTS:Study physicians (n = 78) were residents and faculty practicing in an inner-city, academic primary care general internal medicine practice. Patients (n = 831) received primary care from these physicians and were either at least 75 or between 50 and 74 years of age, with selected morbid conditions. Physicians and patients completed identical questionnaires that included an assessment of their preferences for six specific treatments if they were terminally ill. There were significant differences between physicians' and patients' preferences for all six treatments (p < .0001), with physicians wanting less treatment than their patients for five of them. Patients desiring more care (p < .01) were more often male (odds ratio [OR] 1.7). African-American (OR 1.6), and older (OR 1.02 per year). There were no such correlates with physicians' preferences. A treatment preference score was calculated from respondents' desires to receive or refuse the six treatments. Physicians' scores were highly correlated with those of their enrolled primary care patients (r = .51, p < .0001).

CONCLUSIONS:Although patients and physicians as groups differ substantially in their preferences for end-of-life care, there was significant correlation between individual academic physicians' preferences and those of their primary care patients. Reasons for this correlation are unknown.

译文

目标:医生和患者都认为事前指示很重要,但很少会进行讨论。我们评估了医生与患者对自己的临终护理的需求之间的差异和相关性。

措施和主要结果:研究医师(n = 78)是住院医师以及在市中心的学术初级保健普通内科医学实践中任职的教师。患者(n = 831)从这些医生那里接受了初级护理,年龄至少75岁,或年龄在50-74岁之间,患有特定的病态疾病。内科医生和患者填写了相同的问卷,其中包括如果他们身患绝症,则对他们对六种特定疗法的偏好进行评估。在这六种治疗方法中,医师和患者的偏爱之间存在显着差异(p <.0001),其中五种方法所需要的治疗剂量均少于患者。希望得到更多护理的患者(p <.01)多为男性(优势比[OR] 1.7)。非裔美国人(OR 1.6)和更老的人(每年OR 1.02)。没有这样的关联与医生的喜好。根据受访者接受或拒绝这六种治疗的意愿计算出治疗偏好得分。医师的得分与他们参加的初级保健患者的得分高度相关(r = .51,p <.0001)。他们对临终护理的偏爱,个人学术医生的偏爱与他们的初级保健患者的偏爱之间存在显着相关性。这种关联的原因未知。

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