Decisions about life-sustaining treatment. Impact of physicians' behaviors on the family.
Decisions about life-sustaining treatment. Impact of physicians' behaviors on the family.
复制标题
关于维持生命治疗的决定。
DOI：
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复制
发表时间：
1995
影响因子：
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通讯作者：
C. C. Nelson
中科院分区：
文献类型：
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作者：
V. Tilden;S. Tolle;M. Garland;C. C. Nelson
背景
尽管预先指示越来越多，但重症监护室的大多数患者缺乏书面指示，因此，与家属协商治疗决定仍然是规则。在关于撤回维持生命治疗的决策的背景下，我们调查了哪些医生和护士的行为家庭找到支持，哪些行为增加了家庭的负担。
方法
我们进行了密集的1至2小时长的个人访谈，使用半结构化的采访协议与32名家属的患者没有预先指示，死亡后留在重症监护室和治疗退出。我们使用内容分析技术分析了700多页的逐字访谈数据，并在数据代码上实现了90%以上的评分者一致性。
结果
主题出现的家庭确定选定的医生和护理行为是有益的：鼓励先进的规划，及时沟通，澄清家庭的角色，促进家庭的共识，并容纳家庭的悲痛。使家庭感到被排斥或增加负担的行为包括推迟讨论退出治疗，推迟计划退出，将决策的全部负担放在一个人身上，退出家庭，以及将死亡定义为失败。
结论
研究结果使人们更好地了解家庭未得到满足的需求，并指导医生和护士在参与退出治疗决定时减少增加家庭负担的行动。
BACKGROUND
Despite the growing availability of advance directives, most patients in the intensive care unit lack written directives, and, therefore, consultation with families about treatment decisions remains the rule. In the context of decision making about withdrawing life-sustaining treatments, we investigated which physician and nurse behaviors families find supportive and which behaviors increase the family's burden.
METHODS
We conducted intensive 1- to 2-hour-long individual interviews using a semistructured interview protocol with 32 family members of patients without advance directives whose deaths followed a stay in the intensive care unit and withdrawal of treatment. We analyzed more than 700 pages of verbatim interview data using content analysis techniques and achieved more than 90% interrater agreement on data codes.
RESULTS
Themes emerged as families identified selected physician and nursing behaviors as helpful: encouraging advanced planning, timely communication, clarification of families' roles, facilitating family consensus, and accommodating family's grief. Behaviors that made families feel excluded or increased their burden included postponing discussions about treatment withdrawal, delaying withdrawal once scheduled, placing the full burden of decision making on one person, withdrawing from the family, and defining death as a failure.
CONCLUSIONS
Study findings provide an increased understanding of the unmet needs of families and serve to guide physicians and nurses in reducing actions that increase families' burdens as they participate in treatment withdrawal decisions.