收稿日期: 2025-03-07
网络出版日期: 2026-02-02
基金资助
南京鼓楼医院一般项目(2023-H516)
A qualitative study on barriers to participation in advance care planning among ICU surrogate decision-makers
Received date: 2025-03-07
Online published: 2026-02-02
Supported by
Nanjing Drum Tower Hospital Average Project(2023-H516)
目的 探究ICU替代决策者参与预立医疗照护计划（advance care planning，ACP）决策的障碍因素，为制订决策辅助工具提供依据。方法 2024年10月—12月，基于理论域框架（theoretical domains framework，TDF）制订访谈提纲，选取南京市某三级甲等医院重症医学科18名ICU患者替代决策者进行面对面访谈。按照TDF的相关领域对转录后文本进行分析。结果 结合TDF将ICU替代决策者参与ACP决策的障碍因素归纳出5个主题及13个亚主题：①患者意愿模糊下的执行障碍，②ACP参与过程机制失灵，③社会文化与舆论限制，④决策主体角色认知模糊，⑤情绪驱动下的非理性决策。结论 ICU替代决策者参与ACP决策受多种因素影响，需通过认知重构、沟通优化、情感支持及医疗-社会网络重建，减少其在决策中的负性体验。
夏莲子 , 于斐 , 冯波 , 周慧 , 吉康菱 , 王清 . ICU患者替代决策者参与预立医疗照护计划障碍因素的质性研究[J]. 中华急危重症护理杂志, 2026 , 7(2) : 155 -161 . DOI: 10.3761/j.issn.2096-7446.2026.02.004
Objective To explore the barriers to participation in advance care planning（ACP） decision-making among surrogate decision-makers in the ICU，and to provide a basis for developing decision support tools. Methods From October 2024 to December 2024，an interview guide was developed based on the Theoretical Domains Framework（TDF）. Face-to-face interviews were conducted with 18 surrogate decision-makers of ICU patients in a tertiary hospital in Nanjing. The transcribed texts were analyzed according to the relevant domains of the TDF. Results Based on the TDF，the barriers to ACP decision-making among ICU surrogate decision-makers were categorized into 5 themes and 13 sub-themes： ①Execution barriers under ambiguous patient preferences； ②Breakdown in the procedural mechanisms of ACP participation；③Constraints from sociocultural norms and public discourse； ④Blurred role recognition of the decision-making surrogate； ⑤Irrational decision-making driven by emotions. Conclusion The ACP decision-making of ICU surrogate decision-makers is influenced by multiple factors. Cognitive restructuring，improved communication，emotional support，and reconstruction of the medical-social network are needed to reduce negative experiences during the decision-making process.
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