Decision-making in the ICU: perspectives of the substitute decision-maker
Decision-making in the ICU: perspectives of the substitute decision-maker
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DOI：
10.1007/s00134-002-1569-y
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发表时间：
2003-01-01
影响因子：
38.9
通讯作者：
O'Callaghan, CJ
中科院分区：
文献类型：
--
作者：
Heyland, DK;Cook, DJ;O'Callaghan, CJ
目的：描述重症监护病房（ICU）替代决策者对决策的看法，并确定与他们对决策总体满意度相关的变量。设计：前瞻性、多中心、队列研究。环境：六个加拿大大学附属的icu。患者和参与者：我们分发了一份经过验证的、自我管理的问卷，评估沟通和决策的21个关键方面，以替代机械通气超过48小时的ICU患者的决策者。干预：无。测量与结果：1123名替代决策者接受问卷调查；共回复789份，应答率70.3%。受访者最满意的是与护士的沟通频率，最不满意的是与医生的沟通频率。在对决策的整体满意度方面，560名（70.9%）受访者表示完全满意或非常满意。大多数（81.2%）受访者更喜欢某种形式的共同决策过程。对决策满意度贡献最大的因素包括：对患者所获得的医疗保健水平的完全满意，所收到的信息的完整性，以及在决策过程中感到得到支持。不同地点对决策的满意度差异很大。结论：在这项多中心观察性研究中，我们发现大多数ICU患者的替代决策者希望与医生分享决策责任，总体而言，他们对自己的决策经验感到满意。充分的沟通，感觉支持，以及对其家庭成员达到适当的护理水平是ICU决策满意度的关键决定因素。
Objective: To describe the substitute decision-makers' perspectives related to decision-making in the intensive care unit (ICU) and to determine those variables associated with their overall satisfaction with decision-making. Design: Prospective, multicenter, cohort study. Setting: Six Canadian university-affiliated ICUs. Patients and participants: We distributed a validated, self-administered questionnaire assessing 21 key aspects of communication and decision-making to substitute decision-makers of ICU patients who were mechanically ventilated for more than 48 h. Intervention: None. Measurements and results: A group consisting of 1, 123 substitute decision-makers received questionnaires; 789 were returned (70.3% response rate). Respondents were most satisfied with the frequency of communication with nurses and least satisfied with the frequency of communication with physicians. In terms of overall satisfaction with decision-making, 560 (70.9%) of the respondents were either completely or very satisfied. The majority (81.2%) of respondents preferred some form of shared decision-making process. Factors contributing the most to satisfaction with decision-making included: complete satisfaction with level of health care the patient received, completeness of information received, and feeling supported through the decision-making process. Satisfaction with decision-making varied significantly across sites. Conclusions: In this multicenter observational study, we found that most substitute decision-makers for ICU patients wanted to share decision-making responsibility with physicians and that, overall, they were satisfied with their decision-making experience. Adequate communication, feeling supported, and achieving the appropriate level of care for their family member were key determinants of satisfaction with decision-making in the ICU.