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Patientenorientierte Therapieziele im Krankenhaus : Eine Fragebogenerhebung an medizinischem Personal.
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- Author(s): Umgelter, K.1 ; Landscheidt, J.2; Jäger, K.3; Blobner, M.1; Kochs, E.1; Jäger, K4
- Source:
Anaesthesist. Jul2016, Vol. 65 Issue 7, p499-506. 8p.- Subject Terms:
*MEDICAL care standards; *ATTITUDE (Psychology); *COMPARATIVE studies; *CRITICAL care medicine; *DOCUMENTATION; *GOAL (Psychology); *HEALTH facility employees; *HOSPITAL patients; *HOSPITAL medical staff; *RESEARCH methodology; *MEDICAL cooperation; *MEDICAL personnel; *PATIENTS; *PREOPERATIVE care; *RESEARCH; *ADVANCE directives (Medical care); *EVALUATION research; *DYADIC Adjustment Scale; *ETHICS - Source:
- Additional Information
- Alternate Title: [Pre-operative documentation of individual in-patient therapy goals : A medical staff questionnaire].
- Abstract:
Background: Perioperative care demands consideration of individual treatment goals. We evaluated the attitudes of medical staff towards a short standardized advance directive (SSAD) as a means of improving patient-orientated care at the transition from operating theater to general or intensive care wards.Method: Multicenter anonymized standardized multiple-choice questionnaire among physicians and nurses from various operative and anesthesiology departments. Questions addressing demographic parameters and attitudes towards advance directives in acute care settings (eleven 4‑stepped Likert items). Univariate analysis of group comparisons using the chi-square and Kruskal-Wallis rank-sum test. Multivariable analysis of significant differences employing ordinal logistic regression.Results: The overall return rate was 28.2 % (169 questionnaires). Of these, 19.5 % said that existing advance directives were regularly reassessed preoperatively. SSAD was expected to provide improved emergency care by 82.3 and 76.6 % thought that it would help to better focus intensive care resources according to patients' needs.Discussion: Our study shows the dilemma of insufficiently structured directives for changing treatment goals as well as a high number of legal procedures to obtain proxy decisions due to missing out-patient advance health planning. From a medical staff perspective there is strong support for the concept of SSAD based on medical, ethical, economic and organizational reasons. [ABSTRACT FROM AUTHOR] - Abstract: Einleitung: Die perioperative Betreuung multimorbider und alter Patienten verlangt die Auseinandersetzung mit individuellen werteorientierten Therapiezielen, die von Patientenverfügungen (PV) für Entscheidungen in Akutsituationen zu oft nicht ausreichend dargestellt werden. Wir untersuchten die Eignung einer präoperativ verfassten standardisierten Patientenverfügung in Kurzform (PV-K) zur Verbesserung der Notfall- und Intensivtherapie als alternatives Konzept therapiezielbasierter Vorsorgeplanung. Methode: Multizentrische freiwillige anonyme Fragebogenstudie an Ärzten und Pflegekräften aus allen operativen Fächern und der Anästhesiologie. Erfassung demografischer Parameter sowie der Einschätzung der patientenorientierten Vorausplanung (11 4-stufige Likert-Items). Univariate Analyse durch Gruppen- bzw. Rangsummenvergleiche. Multivariate Analyse durch ordinale logistische Regression. Ergebnis: Rücklaufquote 28,2 % (169 Fragebögen). Existierende PV wurden präinterventionell laut 19,5 % der Mitarbeiter konkretisiert. 82,3 % erwarteten sich durch eine PV-K eine verbesserte medizinische Notfallversorgung und 76,6 % einen patientenorientierteren Einsatz intensivmedizinischer Ressourcen. Die multivariate Analyse identifizierte u. a. Berufstätigkeit in der Pflege als unabhängigen Prädiktor für die Zustimmung zu diesen Aussagen (primärer Endpunkt). Diskussion: Unsere Umfrage belegt einerseits das Dilemma mangelhafter ärztlicher Anordnungen zu Therapiezieländerungen und andererseits die große Anzahl notwendiger gesetzlicher Betreuungsverfahren als Korrelat fehlender ambulanter Vorsorgeplanung. Beim medizinischen Personal besteht eine hohe Akzeptanz gegenüber einer PV-K, deren Bedarf mit medizinischen, medizinethischen, gesundheitsökonomischen und organisatorischen Argumenten begründet wird. [ABSTRACT FROM AUTHOR]
- Abstract: Copyright of Anaesthesist is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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