"You're Socially Distant and Trying Not to Be Emotionally Distant." Physicians' Perspectives of Communication and Therapeutic Relationships in the ICU During the COVID-19 Pandemic: A Qualitative Study.
"You're Socially Distant and Trying Not to Be Emotionally Distant." Physicians' Perspectives of Communication and Therapeutic Relationships in the ICU During the COVID-19 Pandemic: A Qualitative Study.
复制标题
DOI：
10.1097/cce.0000000000000854
复制
发表时间：
2023-02
影响因子：
--
通讯作者：
中科院分区：
文献类型：
--
作者：
目的：1) 描述 COVID-19 相关政策如何影响 ICU 中患者与临床医生的沟通和关系，并关注种族和民族因素；2) 确定可能促进患者与临床医生沟通的干预措施。我们在 2020 年 9 月至 2021 年 2 月期间进行了一项定性研究，探讨了患者与临床医生沟通以及治疗关系形成的促进因素和障碍。我们使用主题分析来得出描述 COVID-19 大流行早期 ICU 内患者沟通和治疗关系的研究结果。我们特意从美国那些经历过早期和/或大量因 COVID-19 住院患者激增的地区选择了医院二人组。我们从退伍军人事务部 (VA) 医疗保健系统及其相关学术附属医院招募了全国 ICU 医生样本。没有任何。来自 7 家 VA 医院和 6 家学术附属医院的 24 名重症监护医生参加了此次研究。重症监护医师指出，这一流行病对持有少数种族和族裔身份的人造成了不成比例的影响，他们描述了语言障碍和限制性探视政策如何加剧了机构的不信任，并损害了医生发展治疗关系的能力。我们还确定了对患者与临床医生沟通和治疗关系建立的几种感知影响。障碍包括医生担心感染 COVID-19 以及使用个人防护设备，这给有效的身体和语言互动造成了障碍。协调员包括现场口译员、使用基于网络的技术与 ICU 外的家庭成员进行互动，以及指定护理团队成员或专家服务来为家庭提供日常更新。 COVID-19 大流行威胁到了 ICU 中患者与临床医生的沟通以及治疗关系的发展，特别是在持有少数种族和民族身份的人及其家人之间。我们确定了几位促进者来改善重症医生认为的患者与临床医生的沟通，这可能有助于增进信任并促进治疗联盟。
To: 1) characterize how COVID-19–related policies influence patient-clinician communication and relationships in the ICU, with attention to race and ethnicity as factors and 2) identify interventions that may facilitate patient-clinician communication. We conducted a qualitative study between September 2020 and February 2021 that explored facilitators and barriers to patient-clinician communication and the formation of therapeutic relationships. We used thematic analysis to develop findings describing patient-communication and therapeutic relationships within the ICU early in the COVID-19 pandemic. We purposively selected hospital dyads from regions in the United States that experienced early and/or large surges of patients hospitalized with COVID-19. We recruited a national sample of ICU physicians from Veteran Affairs (VA) Health Care Systems and their associated academic affiliate hospitals. None. Twenty-four intensivists from seven VA hospitals and six academic-affiliate hospitals participated. Intensivists noted the disproportionate impact of the pandemic on among people holding minoritized racial and ethnic identities, describing how language barriers and restrictive visitation policies exacerbated institutional mistrust and compromised physicians’ ability to develop therapeutic relationships. We also identified several perceived influences on patient-clinician communication and the establishment of therapeutic relationships. Barriers included physicians’ fear of becoming infected with COVID-19 and use of personal protective equipment, which created obstacles to effective physical and verbal interactions. Facilitators included the presence of on-site interpreters, use of web-based technology to interact with family members outside the ICU, and designation of a care team member or specialist service to provide routine updates to families. The COVID-19 pandemic has threatened patient-clinician communication and the development of therapeutic relationships in the ICU, particularly among people holding minoritized racial and ethnic identities and their families. We identified several facilitators to improve patient-clinician communication as perceived by intensivists that may help improve trust and foster therapeutic alliances.