Neglect of quality-of-life considerations in intensive care unit family meetings for long-stay intensive care unit patients.
Neglect of quality-of-life considerations in intensive care unit family meetings for long-stay intensive care unit patients.
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DOI：
10.1097/ccm.0b013e318232d8c4
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发表时间：
2012-02
影响因子：
8.8
通讯作者：
Lipson AR
中科院分区：
文献类型：
--
作者：
Douglas SL;Daly BJ;Lipson AR
研究在正式家庭会议中讨论高死亡率和发病率的长期重症监护病房患者的生活质量和治疗限制的频率。描述性观察性研究。五个重症监护室。116名长期重症监护病房患者的家庭替代决策者参与了旨在提供每周与家庭决策者会面的强化沟通系统。每次会议的结构是讨论医疗更新、患者偏好、治疗计划和评估治疗计划的里程碑。没有。我们为116位家庭决策者录制了最初的家庭会议，共计180次会议。会议平均为24分钟，大部分时间用于非情绪化的演讲，很少（12%）用于讨论患者的偏好。45%的会议讨论了生活质量，23%的会议讨论了治疗限制。当患者被送入重症监护病房（比值比[OR]， 5.9; p = 0.005）、有配偶家庭决策者（比值比，9.4;p = 0.0001）、年龄较大（比值比，1.04;p = 01）、住院时间较短（比值比，0.93;p = 0.001）、有配偶家庭决策者（比值比，5.1;p = 0.002）时，生活质量讨论更有可能发生。对于那些有治疗限制讨论的人，67%的人有不复苏命令，40%的人住进了重症监护病房，56%的家庭决策者曾经是他们的照顾者，48%的家庭决策者是他们的孩子。为了指导与高死亡率和长期发病率的重症监护病房患者子集的家庭讨论，生活质量没有得到一致的解决。需要继续努力协助临床医生进行日常工作，包括讨论生活质量结果。
To examine the frequency with which quality of life and treatment limitation were discussed in formal family meetings for long-stay intensive care unit patients with high risk for mortality and morbidity. Descriptive observational study. Five intensive care units. One hundred sixteen family surrogate decisionmakers of long-stay intensive care unit patients who participated in an intensive communication system that aimed to provide weekly meetings with family decisionmakers. The structure of each meeting was to address medical update, patient preferences, treatment plan, and milestones for evaluating the treatment plan. None. We audiotaped initial family meetings for 116 family decisionmakers for a total of 180 meetings. On average, meetings were 24 mins long with a majority of time being devoted to nonemotional speech and little (12%) spent discussing patient preferences. Quality of life was discussed in 45% and treatment limitation in 23% of all meetings. Quality-of-life discussions were more likely to occur when patients were admitted to a medical intensive care unit (odds ratio [OR], 5.9; p = .005), have a family decisionmaker who is a spouse (OR, 9.4; p = .0001), were older (OR, 1.04; p = 01), have a shorter length of stay (OR, 0.93; p = .001), and have a family decisionmaker who was a spouse (OR, 5.1; p = .002). For those with a treatment limitation discussion, 67% had a do-not-resuscitation order, 40% were admitted to a medical intensive care unit, 56% had a family decisionmaker who had been their caregiver, and 48% of their family decisionmakers were their children. To guide discussion with families of the subset of intensive care unit patients with high risk of mortality and long-term morbidity, quality of life was not consistently addressed. Continued efforts to assist clinicians in routinely including discussions of quality-of-life outcomes is needed.