Late-Life Cardiac Interventions and the Treatment Imperative 英文参考文献.docVIP

Essay Late-Life Cardiac Interventions and the Treatment Imperative Janet K. Shim , Ann J. Russ, Sharon R. Kaufman * I n this Essay, we offer re?ections based on our previously published ethnographic study of physician Summary Points “look forward for” and “treat for risk.” Third, the framing of medical choices for elderly Americans and their physicians is shaped by the Medicare system, in which reimbursement is tied to procedures performed. u The “treatment imperative” refers to the almost inexorable momentum towards intervention that is experienced by physicians, patients, and family members alike. and patient responses to life- extending cardiac procedures that are increasingly performed on ever older individuals in the United States [1]. In that study, we examined how providers and patients considered advanced age in their decision-making about various treatments (angioplasty, stents, bypass surgery, and implantable cardioverter de?brillators), using in-depth interviews with physicians from internal medicine and cardiac subspecialties, cardiac patients aged 72–86, and their family members. The project received institutional review board approval from the University of California, San Francisco, and all interviewees gave informed consent prior to participation. These three developments in cardiac medicine—re?ective of u Even in the presence of reservations about the appropriateness of continued treatment, decisions regarding cardiac treatment in late life are often scripted to favor intervention. wider changes throughout clinical medicine—produced an experience among the physicians we interviewed of an almost inexorable momentum towards treatment. One characterized the successive and escalating cardiac interventions often undertaken for very elderly people as a “speeding train.” Another called it an “extravaganza of cardiology” and a “technology parade,” in which a stream of cardiac specialists each performs a procedure that is medically indicated but also fac