Interpersonal Conflict between Clinicians in the Delivery of Palliative and End-of-Life Care for Critically Ill Patients: A Secondary Qualitative Analysis.
Interpersonal Conflict between Clinicians in the Delivery of Palliative and End-of-Life Care for Critically Ill Patients: A Secondary Qualitative Analysis.
复制标题
临床医生在为危重患者提供姑息治疗和临终关怀时的人际冲突：二次定性分析。
DOI：
10.1089/jpm.2021.0631
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发表时间：
2022
影响因子：
2.8
通讯作者：
Hua,May
中科院分区：
文献类型：
--
作者：
Tong,Wendy;Murali,KomalP;Fonseca,LauraD;Blinderman,CraigD;Shelton,RachelC;Hua,May
背景：临床医生之间的冲突在重症监护病房（ICU）中很普遍，可能会阻碍最佳的护理服务。然而，鲜为人知的是人际冲突的来源，以及它是如何体现在姑息治疗和临终关怀交付的ICUs.Objective的背景下：描述在ICUs.Design的姑息治疗交付的人际冲突：使用演绎归纳法的二次专题分析。我们分析了现有的定性数据，进行半结构化访谈，以检查与ICU中采用专业姑息治疗的变量相关的因素。设置/受试者：在父研究中，从美国的两个城市学术医疗中心招募了36名参与者，包括ICU主治医师（n= 17），ICU护士（n= 11），ICU社会工作者（n= 1）和姑息治疗提供者（n= 7）。测量：编码员应用现有的人际冲突框架来指导初始编码和分析，结合灵活的归纳方法，允许新的代码出现。结果：我们描述了人际冲突的三个特征：不同意，干扰和负面情绪。在为重症患者提供姑息治疗和临终关怀的背景下，“分歧”集中在患者是否适合姑息治疗，哪些护理计划应优先考虑，以及如何提供护理。“干扰”包括阻止姑息治疗咨询或护理目标讨论，并阻碍病人护理。“负面情绪”包括沉默或责骂，粗鲁，愤怒，遗憾，道德冲突，和grace.Conclusions的发生：我们的研究结果提供了一个深入的了解姑息治疗和临终关怀重症患者的人际冲突。需要进一步研究，以了解如何预防和解决此类冲突。
Background:Conflict between clinicians is prevalent within intensive care units (ICUs) and may hinder optimal delivery of care. However, little is known about the sources of interpersonal conflict and how it manifests within the context of palliative and end-of-life care delivery in ICUs.Objective:To characterize interpersonal conflict in the delivery of palliative care within ICUs.Design:Secondary thematic analysis using a deductive–inductive approach. We analyzed existing qualitative data that conducted semistructured interviews to examine factors associated with variable adoption of specialty palliative care in ICUs.Settings/Subjects:In the parent study, 36 participants were recruited from two urban academic medical centers in the United States, including ICU attendings (n= 17), ICU nurses (n= 11), ICU social workers (n= 1), and palliative care providers (n= 7).Measurements:Coders applied an existing framework of interpersonal conflict to guide initial coding and analysis, combined with a flexible inductive approach allowing new codes to emerge.Results:We characterized three properties of interpersonal conflict: disagreement, interference, and negative emotion. In the context of delivering palliative and end-of-life care for critically ill patients, “disagreement” centered around whether patients were appropriate for palliative care, which care plans should be prioritized, and how care should be delivered. “Interference” involved preventing palliative care consultation or goals-of-care discussions and hindering patient care. “Negative emotion” included occurrences of silencing or scolding, rudeness, anger, regret, ethical conflict, and grief.Conclusions:Our findings provide an in-depth understanding of interpersonal conflict within palliative and end-of-life care for critically ill patients. Further study is needed to understand how to prevent and resolve such conflicts.