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首页> 美国卫生研究院文献>BMC Geriatrics >Medical and moral considerations regarding complex medical decisions in older patients with multimorbidity: a compact deliberation framework
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Medical and moral considerations regarding complex medical decisions in older patients with multimorbidity: a compact deliberation framework

机译：涉及多发病的老年患者的复杂医疗决策的医学和道德考量：紧凑的审议框架

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摘要

In health care for older adults, patients with multimorbidity usually receive the same interventions as those patients without multimorbidity. However, standard curative or life-sustaining treatment options have to be considered carefully in view of the maximally attainable result in older and frail patients. To guide such complex medical decisions, we present a compact deliberation framework that could assist physician(s) in charge of the medical treatment of a specific elderly patient to systematize his own thinking about treatment and decisional responsibilities, in case of an intercurrent disease.The framework includes four questions to be addressed when deciding on a single urgent standard curative or life-sustaining intervention in acute medical problems of an elderly patient with multimorbidity: 1) What is known about the patient’s aims and preferences? 2) Will the intervention be effective? 3) Will the intervention support the aims and preferences of the patient? 4) In view of the aims and preferences, will the risks and benefits be in balance?If all four considerations are answered favorably, the intervention will fit patient-centered and appropriate care for frail older patients with multimorbidity.Application to a patient case illustrates how our framework can improve the quality of the shared decision-making process in care for older people and helps clarify medical and moral considerations regarding how to appropriately treat the individual patient.
机译：在老年人的保健中，多发病的患者通常会接受与无多发病的患者相同的干预措施。但是，考虑到老年患者和体弱患者的最大治疗效果，必须仔细考虑标准的治疗或维持生命的治疗方案。为了指导此类复杂的医疗决策，我们提出了一个紧凑的审议框架，该框架可以协助负责特定老年患者的医学治疗，以使他/她在发生并发疾病时对治疗和决策责任的看法系统化。该框架包括四个问题，当决定对患有多种疾病的老年患者的急性医疗问题进行单一的紧急标准治疗或维持生命的干预措施时，要解决的问题：1）对患者的目标和喜好了解多少？ 2）干预是否有效？ 3）干预是否可以支持患者的目的和偏好？ 4）鉴于目标和偏爱，风险和收益是否会平衡？如果四个方面的考虑都得到了满意的回答，则该干预将适合以患者为中心且适当的护理，以应对年龄较弱的多发病例老年患者。我们的框架如何改善护理老年人的共同决策过程的质量，并帮助阐明有关如何适当治疗个别患者的医学和道德考虑。

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