Paths of Emergency Department Care: Development of a Decision Aid to Facilitate Shared Decision Making in Goals of Care Discussions in the Acute Setting.
Paths of Emergency Department Care: Development of a Decision Aid to Facilitate Shared Decision Making in Goals of Care Discussions in the Acute Setting.
复制标题
DOI：
10.1177/23814683211058082
复制
发表时间：
2021-07
影响因子：
--
通讯作者：
Hess EP
中科院分区：
文献类型：
--
作者：
Walker LE;Bellolio MF;Dobler CC;Hargraves IG;Pignolo RJ;Shaw K;Strand JJ;Thorsteinsdottir B;Wilson ME;Hess EP
急诊科（艾德）的护理目标（GOC）对话通常是对代码状态的简短讨论，而不是面向患者的对话。我们的目标是制定一个指南，以促进艾德临床医生和患者之间的对话，以引出患者的价值观，并建立目标的临终关怀，同时保持艾德的效率。艾德护理之路，一个对话指南，就是这项工作的产物。多学科/多专业小组使用推荐的实践来调整适用于艾德患者的GOC对话指南。艾德临床医生使用该指南，并提供有关内容、设计和可用性的反馈。记录患者与临床医生的互动以进行讨论分析，并对两者进行调查以告知迭代改进。与患者代表、多学科临床医生、生物伦理学家和医疗保健设计师进行了一系列讨论，获得了反馈。我们使用了类似于国际患者决策辅助标准的过程，并提供了与这些标准的比较。对话指南，8页，每页尺寸为6 × 6英寸，使用面向患者的提示，包括7个部分：1）评估患者/家属对疾病的理解，2）解释可能的轨迹，3）介绍不同的护理途径，4）解释途径，5）评估理解和关注，6）代码状态，以及7）个性化总结。为该项目招募足够数量的患者/提供者是主要限制。方法仅限于定性分析的指南创建和可行性没有定量分析。艾德护理路径是一个指南，以促进艾德患者，家庭和临床医生关于GOC的以患者为中心的共同决策。这可以确保护理符合患者的价值观和偏好。该指南的使用广受欢迎，并促进了患者和提供者之间有意义的对话。
Goals of care (GOC) conversations in the emergency department (ED) are often a brief discussion of code status rather than a patient-oriented dialogue. We aimed to develop a guide to facilitate conversations between ED clinicians and patients to elicit patient values and establish goals for end-of-life care, while maintaining ED efficiency. Paths of ED Care, a conversation guide, is the product of this work. A multidisciplinary/multispecialty group used recommended practices to adapt a GOC conversation guide for ED patients. ED clinicians used the guide and provided feedback on content, design, and usability. Patient-clinician interactions were recorded for discussion analysis, and both were surveyed to inform iterative refinement. A series of discussions with patient representatives, multidisciplinary clinicians, bioethicists, and health care designers yielded feedback. We used a process similar to the International Patient Decision Aid Standards and provide comparison to these. A conversation guide, eight pages with each page 6 by 6 inches in dimension, uses patient-oriented prompts and includes seven sections: 1) evaluation of patient/family understanding of disease, 2) explanation of possible trajectories, 3) introduction to different pathways of care, 4) explanation of pathways, 5) assessment of understanding and concerns, 6) code status, and 7) personalized summary. Recruitment of sufficient number of patients/providers to the project was the primary limitation. Methods are limited to qualitative analysis of guide creation and feasibility without quantitative analysis. Paths of ED Care is a guide to facilitate patient-centered shared decision making for ED patients, families, and clinicians regarding GOC. This may ensure care concordant with patients’ values and preferences. Use of the guide was well-received and facilitated meaningful conversations between patients and providers.
登录
查看更多内容
影响因子：
3.7
作者：
Coylewright M;Shepel K;Leblanc A;Pencille L;Hess E;Shah N;Montori VM;Ting HH
通讯作者：
Ting HH
影响因子：
4.7
作者：
Grudzen, Corita R.;Richardson, Lynne D.;Morrison, R. Sean
通讯作者：
Morrison, R. Sean
影响因子：
4.4
作者：
George, Naomi R.;Kryworuchko, Jennifer;Platts-Mills, Timothy F.
通讯作者：
Platts-Mills, Timothy F.
DOI：
10.1111/j.1553-2712.2011.01088.x
发表时间：
2011-06-01
期刊：
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
影响因子：
--
作者：
Quest, Tammie E;Asplin, Brent R;Pines, Jesse M
通讯作者：
Pines, Jesse M
影响因子：
1.7
作者：
Chan, GK
通讯作者：
Chan, GK