Half the family members of intensive care unit patients do not want to share in the decision-making process:: A study in 78 French intensive care units
Half the family members of intensive care unit patients do not want to share in the decision-making process:: A study in 78 French intensive care units
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DOI：
10.1097/01.ccm.0000139693.88931.59
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发表时间：
2004-09-01
影响因子：
8.8
通讯作者：
Schlemmer, B
中科院分区：
文献类型：
--
作者：
Azoulay, É;Pochard, F;Schlemmer, B
目的：评价法国重症监护病房工作人员及其家属对家庭参与重症监护病房患者决策的意见。设计：对法国大学附属医院的78个重症监护病房进行前瞻性多中心调查。研究对象：从2001年5月1日开始，我们连续研究了在78个重症监护病房住院的357名患者，每个重症监护病房包括5名患者。干预：记录家庭参与医疗决策的意见和经验。对家庭成员进行理解、满意度、医院焦虑和抑郁量表评分。测量和主要结果。35%的家庭成员理解力差。满意度很好，但73%的家庭成员感到焦虑，35%的家庭成员感到抑郁。在重症监护病房工作人员中，91%的医生和83%的非医生认为应该让家人参与决策；然而，只有39%的人实际让家庭成员参与决策。只有47%的家庭成员表达了参与决策的愿望。只有15%的家庭成员真正参与决策。信息的有效性影响了这一意愿。重症监护病房的工作人员应该设法确定家庭想要多大的自主权。工作人员必须努力找出可能限制其促进自主能力的实际和心理障碍。最后，他们必须制定能够赋予家庭权力的干预措施和态度。
Objective: To evaluate the opinions of intensive care unit staff and family members about family participation in decisions about patients in intensive care units in France, a country where the approach of physicians to patients and families has been described as paternalistic.Design: Prospective multiple-center survey of intensive care unit staff and family members.Setting: Seventy-eight intensive care units in university-affiliated hospitals in France.Patients: We studied 357 consecutive patients hospitalized in the 78 intensive care units and included in the study starting on May 1, 2001, with five patients included per intensive care unit. Interventions: We recorded opinions and experience about family participation in medical decision making. Comprehension, satisfaction, and Hospital Anxiety and Depression Scale scores were determined in family members.Measurements and Main Results. Poor comprehension was noted in 35% of family members. Satisfaction was good but anxiety was noted in 73% and depression in 35% of family members. Among intensive care unit staff members, 91% of physicians and 83% of nonphysicians believed that participation in decision making should be offered to families; however, only 39% had actually involved family members in decisions. A desire to share in decision making was expressed by only 47% of family members. Only 15% of family members actually shared in decision making. Effectiveness of information influenced this desire.Conclusion. Intensive care unit staff should seek to determine how much autonomy families want. Staff members must strive to identify practical and psychological obstacles that may limit their ability to promote autonomy. Finally, they must develop interventions and attitudes capable of empowering families.