The influence of proper medical information to the family of neurocritical patients with extremely poor prognoses
Date Issued
2011
Date
2011
Author(s)
Chen, Te-Fu
Abstract
In the daily practice of neurosurgical surgery, it’s not rare to encounter a patient with poor prognosis which means the patient may not be able to be alert or be capable of self caring thereafter. For a patient with traumatic brain injury, hemorrhagic intracerebral hemorrhage, or stroke, poorer prognosis is documented if the patient presented to the emergency room with Glasgow Coma Scale of less than 6 points and age older than 60 years old. Although there is possibility that the patient might be clear after intensive treatment, generally, the patient tends to be vegetative after surgical intervention such as decompressive craniectomy. Seldom neurosurgeon cares about the caregiver burden and the quality of life for the patient. The goal of the study is to differentiate whether the “detail outcome medical explanation” to the family differ the decision making of surgical intervention for the neurocritical patients with poor neurological outcome. From Aug to Dec, 2010, the study group interviewed 353 persons who is the family of patients receiving treatment in the surgical intensive care units and operation room in the National Taiwan University Hospital. By means of “Different informed vignette questionnaire”-Panel A and B, the decision making and epidemiological data were retrieved from the 290 reclaimed questionnaires [82%]. The result showed in family who are fear of patient’s death, younger aged [less than 50 years old], non-medical background, and male sex [Odds ratio （95% confident interval）: 1.93（1.04~3.58）,2.21（1.17~3.92）,2.03（1.16~2.83）, 3.07（1.64~5.50）] would tent to chose aggressive surgical intervention for the patient with poor outcome, instead of medical treatment only. Furthermore, while the family received more detailed information about the outcome and caregiver burden, they tended to treat the patient medically. We are not going to judge the value of life, but as a medical staff, we should pay great attention to make sure that the family fully understood the benefits and limits of surgical intervention before making decision for such complicated issue.
Subjects
Neurocritical patient
decision making in critical
medical explanation
Type
thesis
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