End-of-Life Decision Making in ICUs: Roles and Relationships of Key Players

描述（由申请方提供）：这是对母研究（重症监护室（ICU）中的临终决策（EOLDM）研究）中收集的数据进行二次分析的建议。 母公司R01在一家医院的4个成人ICU中资助了EOLDM的人种学研究。 该研究的重点是四个ICU之间的文化差异，以及这些文化对有问题的决定的影响。 这项工作已经发表（巴格斯等人，2007年）。 目前的建议有新的研究目标。 它旨在深入关注ICU中EOLDM中关键人员（患者、家庭成员、医生、护士）的角色以及这些人员之间的相互关系。 将使用先前研究中收集的信息丰富的数据进行新的描述性和解释性定性分析（包括来自观察的254个现场记录，人工制品，130人的157次访谈，以及涉及EOLDM的家庭会议的22个录音或大量笔记）。 所有数据均已转录并输入到定性分析中有用的软件数据管理程序（ATLAS.ti）中。 该研究计划的长期目标是改善EOLDM的过程和ICU中做出的EOL决策，ICU是许多此类决策的场所。 不断有证据表明，所做的决定不是最佳的，而且决策过程对患者、家庭和医疗保健提供者来说是痛苦的。 拟议的研究将有助于支持尊重EOLDM所有参与者观点的干预措施。 公共卫生相关性：本建议对重症监护室（ICU）临终决策（EOLDM）的父母人种学研究中收集的数据进行二次分析。 目前的提案采用定性描述，重点关注ICU EOLDM中关键人员（患者、家属、医生、护士）的角色以及这些人员之间的相互关系。 这项研究将有助于支持尊重EOLDM所有参与者观点的干预措施。

DESCRIPTION (provided by applicant): This is a proposal for a secondary analysis of data collected in a parent study, a study of end-of-life decision making (EOLDM) in intensive care units (ICUs). The parent R01 funded ethnographic studies of EOLDM in four adult ICUs in a single hospital. The focus of that study was cultural differences among the four ICUs and the effect of those cultures on cases with problematic decisions. That work has been published (Baggs et al., 2007). The current proposal has new research aims. It is designed to focus in depth on the roles of the key persons in EOLDM in ICUs (patients, family members, physicians, nurses) and the inter-relationships of those persons. A new descriptive and interpretive qualitative analysis will be conducting using the information rich data gathered in the previous study (including 254 fieldnotes from observations, artifacts, 157 interviews of 130 people, and 22 recordings or extensive notes from family meetings involving EOLDM). The data have all been transcribed and entered into a software data management program useful in qualitative analysis (ATLAS.ti). The long term goals of this program of research are to improve the process of EOLDM and the EOL decision made in ICUs, the site of many of these decisions. There is continued evidence that decision made are not optimal, and that the process of decision making is distressing for patients, families, and health care providers. The proposed study will help support interventions respectful of the perspectives of all participants in EOLDM. PUBLIC HEALTH RELEVANCE: This proposal for a secondary analysis of data collected in a parent ethnographic study of end-of-life decision making (EOLDM) in intensive care units (ICUs). The current proposal uses qualitative description to focus on the roles of the key persons in EOLDM in ICUs (patients, family members, physicians, nurses) and the inter-relationships of those persons. The study will help support interventions respectful of the perspectives of all participants in EOLDM.