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

摘要

This study includes 8 RCTs compared Advance Directives and Usual Care published between 2000 and 2016 ,perform systematic review of the literature of AD focus on clinical outcome and the utilization of medical resource,and to offer the relevant suggestions about reimbursement and clinical decision making of Advance Care Planning for end-of-life. The result show that advance care planning encourage the patients and proxy decision maker improved the decision-making process and the completion of advance directive forms in the end of life. Advance care planning appears to be associated with controlling symptoms,relieving depression,respecting the dyingˊs rights,reducing the occurrence of medical dispute,reducing demand for hospital care ICU,and avoiding the use of radical interventions. ADs led to cost savings and increase the efficiency use of medical resources.%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。