The impact of diagnostic disclosure by emergency physicians on family surrogates deciding “Do-not-resuscitate” order for terminally ill patients -an application of the SHARE model

• Main Authors: Ya-Hui Cheng, 鄭雅蕙
• Other Authors: Fen-Ju Chen
• Format: Others
• Language: zh-TW
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/99cb2p

碩士 === 義守大學 === 醫務管理學系 === 106 === Background: When the patient at the end of the disease is sent to the emergency department,the physician needs to explain the condition, and the family surrogates’may also consider to sign the statement of “Do- not- resuscitation”. However, telling bad news in the busy and noisy care environment of the emergency department is not an easy task for the physician.The share mode provides important elements to tell bad news. Purpose: The purpose of this study was to investigate the application of the Share model in emergency physician’s delivery bad news to determine whether it will have an impact on the process and results of family surrogates’signing DNR. Methods: This study adopts a cross-sectional study design and purposive sampling method.The study data sources include observation charts (information notification scales),questionnaire interviews (family interviews), and medical records review (secondary data).Subjects are patients who visits emergency department with condition of the terminal stage of the disease eligible for singing DNR and their families and delegates, for 145 subjects. Data were analyzed using statistical analysis software SPSS 22.0 and analyzed by Chi-square analysis, independent sample t-test, and Logistic regression analysis. Results: There are 145 study subjects. Of 92 subjects sing DNR and the other 53 subjects do not sign DNR. Comparing the implementation status of the two groups of physicians'' performances in telling bad news mode, the supportive environment, how to deliver the bad news, and reassurance and emotional support are better implemented. After controlling the characteristics of patients, their families, and physicians, how to deliver the bad news and reassurance and emotional support are related to signing DNR. Conclusions: Emergency physicians inform patient''s conditions thru Share model, had profound effect on family surrogates’ sign “Do -not- resuscitate” form. This research provides clinical physicians a reference for during critical conditions to guide family surrogates’ sign “Do- not- resuscitate” order, with hope to elevate overall clinical care quality.