Complexity Analysis of Decision-Making in the Critically Ill.
Complexity Analysis of Decision-Making in the Critically Ill.
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DOI：
10.1177/0885066616678394
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发表时间：
2018-10
影响因子：
3.1
通讯作者：
Burant C
中科院分区：
文献类型：
--
作者：
Daly BJ;Douglas SL;O'Toole E;Rowbottom J;Hoffer A;Lipson AR;Burant C
尽管对改善危重病人临终护理的干预措施进行了多次试验，但人们一直缺乏对临终决策障碍相关因素的了解。应用复杂性科学的原则来检查在何种程度上过渡到临终关怀可以由医生，家属，或病人的特点预测；结果预期;以及治疗效果的评价。一项描述性的纵向研究在3个成人重症监护病房（icu）进行。每5天对264名缺乏决策能力患者的家庭代理人和照顾患者的医生进行一次访谈，直至患者出院或死亡。患者、医生和家庭成员的特征；医生和家庭的价值观和偏好；以及对治疗效果的评估，对患者结果的期望，以及治疗的相对优先级（舒适与生存）。主要结局，护理重点，被分类为(1)维持生存导向（无治疗限制），(2)过渡到更强的姑息性焦点（例如，一些治疗限制），或(3)过渡到明确的临终关怀，以舒适为导向的护理计划。医生对生存和未来认知状态的期望是唯一与护理重点一致且显著相关的变量。医生或家庭对治疗效果的评估以及对医生或家庭成员最重要的因素都没有影响。与生存概率的一致影响相比，缺乏家庭和医生观点的影响表明，在治疗决策中纳入个人价值观存在障碍。
Despite multiple trials of interventions to improve end-of-life care of the critically ill, there is a persistent lack of understanding of factors associated with barriers to decision-making at the end of life. To apply the principles of complexity science in examining the extent to which transitions to end-of-life care can be predicted by physician, family, or patient characteristics; outcome expectations; and the evaluation of treatment effectiveness. A descriptive, longitudinal study was conducted in 3 adult intensive care units (ICUs). Two hundred sixty-four family surrogates of patients lacking decisional capacity and the physicians caring for the patients were interviewed every 5 days until ICU discharge or patient death. Characteristics of patients, physicians, and family members; values and preferences of physicians and family; and evaluation of treatment effectiveness, expectations for patient outcomes, and relative priorities in treatment (comfort vs survival). The primary outcome, focus of care, was categorized as (1) maintaining a survival orientation (no treatment limitations), (2) transitioning to a stronger palliative focus (eg, some treatment limitations), or (3) transitioning to an explicit end-of-life, comfort-oriented care plan. Physician expectations for survival and future cognitive status were the only variables consistently and significantly related to the focus of care. Neither physician or family evaluations of treatment effectiveness nor what was most important to physicians or family members was influential. Lack of influence of family and physician views, in comparison to the consistent effect of survival probabilities, suggests barriers to incorporation of individual values in treatment decisions.
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影响因子：
3.7
作者：
Myburgh, John;Abillama, Fayez;Zimmerman, Janice
通讯作者：
Zimmerman, Janice
影响因子：
8.8
作者：
Turnbull, Alison E.;Krall, Jenna R.;Needham, Dale M.
通讯作者：
Needham, Dale M.
影响因子：
8.8
作者：
Lilly, CM;Sonna, LA;Massaro, AF
通讯作者：
Massaro, AF
影响因子：
8.8
作者：
Kahn JM;Le T;Angus DC;Cox CE;Hough CL;White DB;Yende S;Carson SS;ProVent Study Group Investigators
通讯作者：
ProVent Study Group Investigators
DOI：
10.1111/j.1532-5415.1999.tb02573.x
发表时间：
1999-05-01
影响因子：
6.3
作者：
Mebane, EW;Oman, RF;Goldstein, MK
通讯作者：
Goldstein, MK