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  1. A controlled trial to improve care for seriously III hospitalized patients : the study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT).

    Article - En anglais

    Objectives

    - To improve end-of-life decision making and reduce the frequency of a mechanically supported, painful, and prolonged process of dying.

    Design

    - A 2-year prospective observational study (phase I) with 4301 patients followed by a 2-year controlled clinical trial (phase II) with 4804 patients and their physicians randomized by specialty group to the intervention group (n=2652) or control group (n=2152).

    Setting

    - Five teaching hospitals in the United States.

    Patients

    - A total of 9105 adults hospitalized with one or more of nine life-threatening diagnoses ; an overall 6-month mortality rate of 47%. Intervention. - Physicians in the intervention group received estimates of the likelihood of 6-month survival for every day up to 6 months, outcomes of cardiopulmonary resuscitation (CPR), and functional disability at 2 months.

    A specially trained nurse had multiple contacts with the patient, family, physician, and hospital staff to elicit preferences, improve understanding of outcomes, encourage attention to pain control, and facilitate advance care planning and patient-physician communication.

    Results

    - The phase I observation documented shortcomings in communication, frequency of aggressive treatment, and the characteristics of hospital death : only 47% of physicians knew when their patients preferred to avoid CPR ; 46% of do-not-resuscitate (DNR) orders were written within 2 days of death.

    Mots-clés Pascal : Soin, Hôpital, Etats Unis, Traitement, Homme, Etude SUPPORT, Fin de vie, Amérique du Nord, Amérique

    Mots-clés Pascal anglais : Care, Hospital, United States, Treatment, Human, North America, America

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 96-0028511

    Code Inist : 002B30A01C. Création : 01/03/1996.