Dying in the ICU - Perspectives of family members
Dying in the ICU - Perspectives of family members
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DOI：
10.1378/chest.124.1.392
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发表时间：
2003-07-01
期刊：
影响因子：
9.6
通讯作者：
Cook, DJ
中科院分区：
文献类型：
--
作者：
Heyland, DK;Rocker, GM;Cook, DJ
目的：描述家属对ICU死亡危重病人护理的看法。设计：多中心、前瞻性、观察性研究。地点：加拿大6所大学附属ICU。方法：在ICU死亡的危重病人接受机械呼吸机治疗48小时后，符合研究条件。在患者去世三到四周后，我们向一名选定的家庭成员邮寄了一份经过验证的问卷，该成员至少在ICU探望过患者一次。我们在临终关怀、沟通和决策的关键方面获得了自我评估的满意度水平。主要结果：对413名家庭成员进行问卷调查，回收问卷256份(回复率62.0%)。在患者死亡前的最后几个小时，家属报告称，患者“完全舒适”(34.8%)、“非常舒适”(23.8%)或“基本舒适”(32.0%)。57.0%的家庭成员感受到医疗团队对家庭的支持，30.7%的家庭成员感到受到医疗团队的支持。大多数人(82.0%)认为患者的生命既没有不必要的延长也没有不必要的缩短。大多数家庭成员(90.4%)倾向于某种形式的共同决策。总体而言，52%的家庭对护理工作的满意度为“极好”，31%的家庭对护理工作的满意度为“非常好”，10%的家庭对护理服务的满意度为“良好”，4%的家庭对护理服务的满意度为“一般”，2%的家庭对护理服务的满意度为“差”。对临终关怀的总体满意度与家属收到的信息的完整性、对患者和家属的尊重和同情、对接受的医疗护理数量和水平的满意度显著相关。结论：大多数在参与ICU死亡的患者的家属对所提供的临终关怀感到满意。充分的沟通，良好的决策，以及对临终病人及其家人的尊重和同情，是家庭满意度的关键决定因素。
Objective: To describe the perspectives of family members to the care provided to critically ill patients who died in the ICU.Design: Multicenter, prospective, observational study.Setting: Six university-affiliated ICUs across Canada.Methods: Patients who received mechanical ventilation for > 48 h and who died in the ICU were eligible for this study. Three to four weeks after the patient's death, we mailed a validated questionnaire to one selected family member who made at least one visit to the patient in the ICU. We obtained self-rated levels of satisfaction with key aspects of end-of-life care, communication, and decision making.. and the overall ICU experience.Main results; Questionnaires were mailed to 413 family members; 256 completed surveys were returned (response rate, 62.0%). in the final hours before the death of the patient, family members reported that patients were "totally comfortable" (34.8%), "very comfortable" (23.8%), or "mostly comfortable" (32.0%). Family members felt "very supported" (57.0%) and "supported" (30.7%) by the health-care team. Most (82.0%) believed that the patient's life was neither prolonged nor shortened unnecessarily. Most family members (90.4%) preferred some form of shared decision making. Overall, 52% of families rated their satisfaction with care as "excellent," 31% rated care as "very good," 10% as "good," 4% as "fair," and 2% as "poor." Overall satisfaction with end-of-life care was significantly associated with completeness of information received by the family member, respect and compassion shown to patient and family member, and satisfaction with amount or level of health care received.Conclusions: The majority of families of patients who died in participating ICUs were satisfied with the end-of-life care provided. Adequate communication, good decision making, and respect and compassion shown to both the dying patient and their family are key determinants to family satisfaction.