ICU无行为能力患者替代决策的研究进展

doi:10.3761/j.issn.2096-7446.2022.01.014

摘要/Abstract

摘要： ICU无行为能力患者由于病情危重或深度镇静无法做出治疗决定,该群体医疗决策选择是临床实践的难点。该文综述了替代决策的概念、主体和内容,分析了替代决策的影响因素,提出了替代决策的引导策略,包括加强替代决策者教育、加强医护人员培训、加强沟通交流和决策辅助4个方面,可为替代决策者做出最优选择及替代决策的相关研究发展提供参考依据。

关键词: 重症监护病房, 无行为能力患者, 替代决策, 综述, 危重病护理

Abstract: Incapacitated patients in ICU are unable to make treatment decisions due to critically ill condition or deep sedation,and their choice of medical decisions is a difficult point in clinical practice. This paper introduces the concept,main body and contents of surrogate decision-making,analyzes the factors affecting surrogate decision-making,and proposed four guiding strategies of surrogate decision-making including strengthening the education of surrogate decision makers and medical staff,strengthening communication and decision aids. It can provide some reference for surrogate decision maker to make the optimal choice and the related research development of surrogate decision.

Key words: Intensive Care Units, Incapacitated Patient, Surrogate Decision Making, Review, Critical Care Nursing

张佳佳, 陈凤, 宫晓艳, 周羽子, 庄一渝. ICU无行为能力患者替代决策的研究进展[J]. 中华急危重症护理杂志, 2022, 3(1): 78-82.

ZHANG Jiajia, CHEN Feng, GONG Xiaoyan, ZHOU Yuzi, ZHUANG Yiyu. Review on surrogate decision-making for incapacitated patients in ICU[J]. Chinese Journal of Emergency and Critical Care Nursing, 2022, 3(1): 78-82.

参考文献

[1] 刘倩丽,关健. 基于数据的临床决策对无行为能力患者治疗选择的潜在意义[J]. 中国医学伦理学,2016,29(6):978-980.
Liu QL,Guan J.The potential significance of data-based decision-making to clinical choice of incapacitated patients[J]. Chin Med Ethics,2016,29(6):978-980.
[2] 刘俊荣,吴开,谢汉春. 医疗决策模式与决策主体的选择倾向研究[J]. 医学与哲学(A),2018,39(10):14-20.
Liu JR,Wu K,Xie HC.Study on medical decision-making mo-dels and decision-makers' preferences[J]. Med Philos A,2018, 39(10):14-20.
[3] 余晓,田刻平,张小红,等. 危重患者临终决策的研究现状[J]. 中国护理管理,2017,17(2):271-275.
Yu X,Tian KP,Zhang XH,et al.The research progress of end-of-life decisions among ICU patients[J]. Chin Nurs Manag,2017, 17(2):271-275.
[4] Scheunemann LP,Ernecoff NC,Buddadhumaruk P,et al.Clinician-family communication about patients' values and preferences in intensive care units[J]. JAMA Intern Med,2019,179(5):676-684.
[5] Sulmasy DP,Hughes MT,Yenokyan G,et al.The trial of ascertaining individual preferences for loved ones' role in end-of-life decisions(TAILORED) study:a randomized controlled trial to improve surrogate decision making[J]. J Pain Symptom Ma-nage,2017,54(4):455-465.
[6] Khan MW,Muehlschlegel S.Shared decision making in neurocritical care[J]. Neurol Clin,2017,35(4):825-834.
[7] Thiede E,Levi BH,Lipnick D,et al.Effect of advance care planning on surrogate decision makers' preparedness for decision making:results of a mixed-methods randomized controlled trial[J]. J Palliat Med,2021,24(7):982-993.
[8] Mendoza JL,Burns CM.‘Who Will Talk for Me?’ next of kin is not necessarily the preferred substitute decision maker:findings from an Australian intensive care unit[J]. Palliat Med, 2015, 29(4):391-392.
[9] Jox RJ,Denke E,Hamann J,et al.Surrogate decision making for patients with end-stage dementia[J]. Int J Geriatr Psychiatry,2012,27(10):1045-1052.
[10] Masuda Y,Fetters M,Shimokata H,et al.Outcomes of written living wills in Japan:a survey of the deceased ones' families[J]. Bioethics Forum,2001,17(1):41-52.
[11] Dzeng E,Colaianni A,Roland M,et al.Influence of institutional culture and policies on do-not-resuscitate decision making at the end of life[J]. JAMA Intern Med,2015,175(5):812-819.
[12] Heland M.Fruitful or futile:intensive care nurses' experiences and perceptions of medical futility[J]. Aust Crit Care,2006, 19(1):25-31.
[13] 崔娟,王云岭. 论医务社会工作本土化过程中的伦理困境及对策:以“案主自决”原则与中国本土价值观冲突为例[J]. 中国医学伦理学,2014,27(5):670-672.
Cui J,Wang YL.Ethical dilemmas and related solutions for localization of medical social work:taking conflicts between “self determination” principle and Chinese local values for example[J]. Chin Med Ethics,2014,27(5):670-672.
[14] 朱懿珍,张爽,关玉珠,等. 共享决策在ICU中的应用进展[J]. 中华护理杂志,2021,56(2):289-294.
Zhu YZ,Zhang S,Guan YZ,et al.Application progress of shared decision-making in ICU[J]. Chin J Nurs,2021,56(2):289-294.
[15] Jones TW,Newsome AS,Smith SE,et al.Interprofessional sha-red decision-making:who is at the table?[J]. Crit Care Med,2020,48(2):e158-e159.
[16] 刘梦婕,朱京慈. “不再心肺复苏”在ICU的应用进展[J]. 中华护理杂志,2016,51(5):613-617.
Liu MJ,Zhu JC.Progress on application of do-not-resuscitate orders in ICUs[J]. Chin J Nurs,2016,51(5):613-617.
[17] McKenzie MS,Auriemma CL,Olenik J,et al. An observational study of decision making by medical intensivists[J]. Crit Care Med,2015,43(8):1660-1668.
[18] Johnson SK,Bautista CA,Hong SY,et al.An empirical study of surrogates' preferred level of control over value-laden life support decisions in intensive care units[J]. Am J Respir Crit Care Med,2011,183(7):915-921.
[19] Fan SY,Hsieh JG.The experience of do-not-resuscitate orders and end-of-life care discussions among physicians[J]. Int J En-viron Res Public Health,2020,17(18):E6869.
[20] Wendler D,Rid A.Systematic review:the effect on surrogates of making treatment decisions for others[J]. Ann Intern Med,2011,154(5):336-346.
[21] Bolcic-Jankovic D,Clarridge BR,LeBlanc JL,et al. Exploring determinants of surrogate decision-maker confidence:an example from the ICU[J]. J Empir Res Hum Res Ethics,2014,9(4):76-85.
[22] Lerner JS,Li Y,Valdesolo P,et al.Emotion and decision mak-ing[J]. Annu Rev Psychol,2015,66(1):799-823.
[23] Beckstrand RL,Jenkins JB,Luthy KE,et al.Family behaviors as unchanging obstacles in end-of-life care:16-year comparative data[J]. Am J Crit Care,2020,29(4):e81-e91.
[24] Leibold A,Lassen CL,Lindenberg N,et al.Is every life worth saving:does religion and religious beliefs influence parame-dic's end-of-life decision-making? A prospective questionnaire-based investigation[J]. Indian J Palliat Care,2018,24(1):9-15.
[25] Ayeh DD,Tak HJ,Yoon JD,et al.U.S. physicians' opinions about accommodating religiously based requests for continued life-sustaining treatment[J]. J Pain Symptom Manage,2016,51(6):971-978.
[26] Anstey MH,Litton E,Jha N,et al.A comparison of the opinions of intensive care unit staff and family members of the treatment intensity received by patients admitted to an intensive care unit:a multicentre survey[J]. Aust Crit Care,2019, 32(5):378-382.
[27] Robinson J,Gott M,Ingleton C.Patient and family experiences of palliative care in hospital:what do we know? An integrative review[J]. Palliat Med,2014,28(1):18-33.
[28] Wilson ME,Krupa A,Hinds RF,et al.A video to improve patient and surrogate understanding of cardiopulmonary resuscitation choices in the ICU:a randomized controlled trial[J]. Crit Care Med,2015,43(3):621-629.
[29] Cresp SJ,Lee SF,Moss C.A framework for nurses working in partnership with substitute decision-makers for people living with advanced dementia:a discursive paper[J]. J Clin Nurs,2020:1-10.
[30] Cai XM,Robinson J,Muehlschlegel S,et al.Patient preferen-ces and surrogate decision making in neuroscience intensive care units[J]. Neurocrit Care,2015,23(1):131-141.
[31] Au SS,Roze des Ordons AL,Parsons Leigh J,et al. A multicenter observational study of family participation in ICU rounds[J]. Crit Care Med,2018,46(8):1255-1262.
[32] 张冰冰,聂琴琪,王婉洁,等. 治疗决策辅助在ICU长期机械通气病人家属中的应用效果[J]. 护理研究,2018,32(21):3453-3456.
Zhang BB,Nie QQ,Wang WJ,et al.Application effect of treatment decision support for families of ICU patients with long-term mechanical ventilation[J]. Chin Nurs Res,2018,32(21):3453-3456.
[33] Plaisance A,Witteman HO,LeBlanc A,et al. Development of a decision aid for cardiopulmonary resuscitation and invasive mechanical ventilation in the intensive care unit employing user-centered design and a wiki platform for rapid prototyping[J]. PLoS One,2018,13(2):e0191844.