Factors Associated With Family Satisfaction With End-of-Life Care in the ICU
Factors Associated With Family Satisfaction With End-of-Life Care in the ICU
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DOI：
10.1378/chest.14-1098
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发表时间：
2015-01-01
期刊：
影响因子：
9.6
通讯作者：
Torke, Alexia M.
中科院分区：
文献类型：
--
作者：
Hinkle, Laura J.;Bosslet, Gabriel T.;Torke, Alexia M.
背景：家庭对ICU临终关怀的满意度以前没有被系统地回顾过。我们的目的是进行一项综述，综合已发表的数据，确定与危重成人患者临终关怀的家庭满意度相关的因素。方法：检索以下电子数据库：MEDLINE（医学文献分析与检索系统在线）、MEDLINE Updated、EMBASE（医学数据库摘要）、CINAHL（护理及相关健康文献累积索引）、PsycInfo和PubMed。两位作者审阅了检索到的标题和摘要。排除了描述非成人和非icu人群或不涉及临终关怀、家庭满意度或影响满意度因素的研究。其余的文章由两位作者进行了全面的审查和数据提取。根据综合报告试验标准小组的建议，使用清单对质量进行评估。结果：检索到1072篇文章，其中23篇文章描述了14项符合纳入标准的研究。所有研究均通过调查和结构化访谈从家庭成员中获得满意度数据。提高满意度的具体沟通策略包括：表达同情、不放弃、保证舒适和提供书面信息。此外，对共同决策的支持，死亡时的家人在场，以及临终前拔管等具体的病人护理措施与满意度的提高有关。结论：高质量的沟通、对共同决策的支持和具体的患者护理措施与临终关怀满意度的提高有关。评估家庭参与共同决策的意愿也可能是一个重要因素。很少的干预增加了满意度。未来的研究需要进一步确定最佳的沟通策略，了解姑息治疗与ICU的有效整合，并确定调查工具的显著评分变化。
BACKGROUND: Family satisfaction with end-of-life care in the ICU has not previously been systematically reviewed. Our objective was to perform a review, synthesizing published data identifying factors associated with family satisfaction with end-of-life care in critically ill adult populations.METHODS: The following electronic databases were searched: MEDLINE (Medical Literature Analysis and Retrieval System Online), MEDLINE Updated, EMBASE (Excerpta Medical Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), PsycInfo, and PubMed. Two authors reviewed retrieved titles and abstracts. Studies describing nonadult and non-ICU populations or not addressing end-of-life care, family satisfaction, or factors affecting satisfaction were excluded. The remaining articles underwent full review and data extraction by two authors. Quality was assessed using a checklist based on the recommendations of the Consolidated Standards for Reporting Trials group.RESULTS: The search yielded 1,072 articles, with 23 articles describing 14 studies meeting inclusion criteria. All studies obtained satisfaction data from family members via surveys and structured interviews. Specific communication strategies increasing satisfaction included: expressions of empathy, nonabandonment, and assurances of comfort and provision of written information. Additionally, support for shared decision-making, family presence at time of death, and specific patient-care measures such as extubation before death were associated with increased satisfaction.CONCLUSIONS: Good-quality communication, support for shared decision-making, and specific patient-care measures were associated with increased satisfaction with end-of-life care. Assessing the family's desire to participate in shared decision-making may also be an important factor. Few interventions increased satisfaction. Future research is needed to further define optimal communication strategies, understand effective integration of palliative care into the ICU, and define significant score changes in survey instruments.