Shared Decision Making in ICUs: An American College of Critical Care Medicine and American Thoracic Society Policy Statement.
Shared Decision Making in ICUs: An American College of Critical Care Medicine and American Thoracic Society Policy Statement.
复制标题
重症监护病房中的共同决策：美国重症医学会和美国胸科学会的政策声明
DOI：
10.1097/ccm.0000000000001396
复制
发表时间：
2016-01
影响因子：
8.8
通讯作者：
American Thoracic Society
中科院分区：
文献类型：
--
作者：
Kon AA;Davidson JE;Morrison W;Danis M;White DB;American College of Critical Care Medicine;American Thoracic Society
共享决策 (SDM) 得到了重症监护组织的认可，但对于 SDM 是什么、何时应该使用以及促进治疗决策中的伙伴关系的方法仍然存在困惑。本声明的目的是定义 SDM，建议何时应使用 SDM，确定道德上可接受的决策模型的范围，并介绍重要的沟通技巧。美国重症监护医学会 (ACCM) 和美国胸科学会 (ATS) 伦理委员会审查了同行评审期刊上发表的实证研究和规范分析，以提出建议。声明中包含了 ACCM 和 ATS 全体道德委员会一致批准的建议。批准了六项建议： 1) 定义：共享决策是一个协作过程，允许患者或其代理人和临床医生一起做出医疗保健决策，同时考虑现有的最佳科学证据以及患者的价值观、目标和偏好。 2) 临床医生在做出可能受个人价值观、目标和偏好影响的重大治疗决策时，应参与 SDM 流程来定义总体护理目标（包括有关限制或撤回延长生命的干预措施的决定）。 3) 临床医生应使用 SDM 流程作为其“默认”方法，该流程包括三个主要要素：信息交换、审议和做出治疗决定。 4) 广泛的决策方法在伦理上是可支持的，包括患者或代理人导向和临床医生导向的模型。临床医生应根据患者或代理人的偏好调整决策过程。 5) 临床医生应接受沟通技巧培训。 6) 需要进行研究来评估决策策略。患者和代理人对有价值的选择的决策角色的偏好范围从倾向于行使重要权力到将这种权力让给提供者。临床医生应根据患者或代理人的需求和偏好调整决策模型。
Shared decision-making (SDM) is endorsed by critical care organizations, however there remains confusion about what SDM is, when it should be used, and approaches to promote partnerships in treatment decisions. The purpose of this statement is to define SDM, recommend when SDM should be used, identify the range of ethically acceptable decision-making models, and present important communication skills. The American College of Critical Care Medicine (ACCM) and American Thoracic Society (ATS) Ethics Committees reviewed empirical research and normative analyses published in peer-reviewed journals to generate recommendations. Recommendations approved by consensus of the full Ethics Committees of ACCM and ATS were included in the statement. Six recommendations were endorsed: 1) Definition: Shared decision-making is a collaborative process that allows patients, or their surrogates, and clinicians to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values, goals, and preferences. 2) Clinicians should engage in a SDM process to define overall goals of care (including decisions regarding limiting or withdrawing life-prolonging interventions) and when making major treatment decisions that may be affected by personal values, goals, and preferences. 3) Clinicians should use as their “default” approach a SDM process that includes three main elements: information exchange, deliberation, and making a treatment decision. 4) A wide range of decision-making approaches are ethically supportable including patient- or surrogate-directed and clinician-directed models. Clinicians should tailor the decision-making process based on the preferences of the patient or surrogate. 5) Clinicians should be trained in communication skills. 6) Research is needed to evaluate decision-making strategies. Patient and surrogate preferences for decision-making roles regarding value-laden choices range from preferring to exercise significant authority to ceding such authority to providers. Clinicians should adapt the decision-making model to the needs and preferences of the patient or surrogate.