ICU患者照顾者代理决策体验质性研究的Meta整合

doi:10.3761/j.issn.0254-1769.2023.16.018

摘要/Abstract

摘要：

目的总结ICU患者照顾者进行代理决策的感受与体验，为护理人员制订干预方案，帮助照顾者作出最佳决策提供参考依据。方法系统检索PubMed、Web of Science、Embase、Cochrane Library、PsycINFO、CINAHL、中国生物医学文献服务系统、中国知网、万方数据库、维普数据库，检索关于ICU患者照顾者决策体验的文献，检索时限为建库至2023年3月1日。根据澳大利亚乔安娜布里格斯研究所循证卫生保健中心质性研究质量评价标准（2020版）对纳入文献进行质量评价，采用汇集性整合方法对研究结果进行总结与归纳。结果共纳入10篇文献，提取40个主题，归纳为11个类别，合并为3个整合结果：决策时的复杂心理、做出决策判断的依据、影响决策的因素。结论护理人员应该及时关注ICU患者照顾者进行代理决策时的体验，并给予充分的心理支持，从而帮助患者选择最佳治疗方案，改善其救治成功率和生活质量。

关键词: 危重症患者, 代理决策者, 质性研究, Meta整合, 护理

Abstract:

Objective To summarize the feelings and experiences of surrogate decision makers of patients in ICU，and to provide references for clinical healthcare professionals to develop intervention plans and assist surrogate decision-makers in making the best decisions. Methods PubMed，Web of Science，Embase，Cochrane Library，PsycINFO，CINAHL，China Biomedical Literature Service System，China National Knowledge Network，Wanfang database and VIP database were searched systematically. The studies on the qualitative research of caregiver decision making experience for critically ill patients were searched until March 1，2023. The 2020 edition of the Joanna Briggs Institute（JBI） Quality Evaluation criteria for Evidence-Based health care centers was used to evaluate the quality of the included literature，and the findings were summarized using a pooled integration approach. Results A total of 10 pieces of literature were included，and a total of 40 topics were extracted and summarized into 11 categories，which were combined into 3 integrated results：complex psychologic status in decision making，the basis for making decisions and judgments，numerous factors affecting decision making. Conclusion Medical staff should pay attention to the psychological feelings of surrogate decision makers when making decisions，and give adequate psychological support，help patients choose the best treatment plan，improve the success rate of treatment and quality of life.

Key words: Critically Ill Patients, Surrogate Decision Makers, Qualitative Research, Meta-Synthesis, Nursing Care

程志强, 张宝珍, 夏娇云, 李夏欣, 周钰珏, 王小星, 付焕旭, 闫程坤. ICU患者照顾者代理决策体验质性研究的Meta整合[J]. 中华护理杂志, 2023, 58(16): 2027-2033.

CHENG Zhiqiang, ZHANG Baozhen, XIA Jiaoyun, LI Xiaxin, ZHOU Yujue, WANG Xiaoxing, FU Huanxu, YAN Chengkun. The decision making experience of surrogate decision makers for critically ill patients：a qualitative Meta-synthesis research[J]. Chinese Journal of Nursing, 2023, 58(16): 2027-2033.

图/表 3

图1 文献筛选流程图

Figure 1 Flow chart of literature screening

表1 纳入文献基本特征（n=10）

Table 1 The basic characteristics of the included literature（n=10）

表2 纳入文献质量评价（n=10）

Table 2 Methodological quality evaluation of the included literature（n=10）

参考文献 27

[1]	Geddis-Regan A, Errington L, Abley C, et al. Enhancing shared and surrogate decision making for people living with demen-tia:a systematic review of the effectiveness of interventions[J]. Health Expect, 2021, 24(1):19-32. DOI PMID
[2]	张泽涵, 苗波, 闫晓霞, 等. 脑死亡患者家属器官捐献决策体验的Meta整合[J]. 中华护理杂志, 2023, 58(4):485-492. DOI
	Zhang ZH, Miao B, Yan XX, et al. The decision-making ex-perience of the families of patients with brain death:a Meta synthesis of qualitative studies[J]. Chin J Nurs, 2023, 58(4):485-492.
[3]	安晓, 薛雅婷, 夏雨, 等. ICU患者替代决策者决策疲劳现状及影响因素分析[J]. 中华护理杂志, 2023, 58(8):949-955. DOI
	An X, Xue YT, Xia Y, et al. Current status of decision fatigue among substitutive decision makers of ICU patients and its influencing factors[J]. Chin J Nurs, 2023, 58(8):949-955. DOI
[4]	刘雪冰, 刘东玲, 朱婷婷, 等. 国外代理决策相关研究的文献计量学分析[J]. 解放军护理杂志, 2021, 38(10):40-43,46.
	Liu XB, Liu DL, Zhu TT, et al. Bibliometric analysis of resear-ch in surrogate decision-making abroad[J]. Nurs J Chin PLA, 2021, 38(10):40-43,46.
[5]	陈佳丽, 曾莉. 代理决策在重症监护室患者护理中的应用进展[J]. 解放军护理杂志, 2022, 39(4):77-80.
	Chen JL, Zeng L. Application progress of proxy decision-making in intensive care unit patient care[J]. Nurs J Chin PLA, 2022, 39(4):77-80.
[6]	Lockwood C, Porritt K, Munn Z, et al. Chapter 2:systematic re-views of qualitative evidence[M]. JBI Manual for Evidence Syn-thesis, 2020.
[7]	Ermers DJM, Ploos van Amstel FK, et al. Experiences of bereaved family caregivers with shared decision making in palliative cancer treatment:a qualitative interview study[J]. BMC Palliat Care, 2021, 20(1):137. DOI
[8]	Li LS, Nelson JE, Hanson LC, et al. How surrogate decision-makers for patients with chronic critical illness perceive and carry out their role[J]. Crit Care Med, 2018, 46(5):699-704. DOI PMID
[9]	Tanaka M, Ohnishi K, Enzo A, et al. Grounds for surrogate de-cision-making in Japanese clinical practice:a qualitative sur-vey[J]. BMC Med Ethics, 2021, 22(1):1-12. DOI
[10]	Burns KE, Prats CJ, Maione M, et al. The experience of surro-gate decision makers on being approached for consent for patient participation in research. A multicenter study[J]. Ann Am Thorac Soc, 2017, 14(2):238-245. DOI URL
[11]	Chen JL, Zeng L, Liu XL, et al. Family surrogate decision-ma-kers’ perspectives in decision-making of patients with disor-ders of consciousness[J]. Neuropsychol Rehabil, 2022, 16(3):1-16. DOI URL
[12]	Kuehlmeyer K, Domenico Borasio G, Jox RJ. How family care-givers’ medical and moral assumptions influence decision making for patients in the vegetative state:a qualitative interview study[J]. J Med Ethics, 2012, 38(6):332-337. DOI PMID
[13]	Lane T, Brereton E, Nowels C, et al. Surrogate informed con-sent:a qualitative analysis of surrogate decision makers’ pers-pectives[J]. Ann Am Thorac Soc, 2021, 18(7):1185-1190. DOI URL
[14]	Kuniavsky M, van Heerden PV, Kadmon I, et al. Attitudes of legal guardians in the ICU:a qualitative report[J]. Intensive Crit Care Nurs, 2014, 30(2):86-92. DOI URL
[15]	郭园丽, 马珂珂, 杨彩侠, 等. 急性缺血性脑卒中患者及代理决策者溶栓决策的质性研究[J]. 护理学杂志, 2021, 36(16):43-46.
	Guo YL, Ma KK, Yang CX, et al. Decision-making of throm-bolytic therapy among acute ischemic stroke patients and their surrogates:a qualitative study[J]. J Nurs Sci, 2021, 36(16):43-46.
[16]	Tseng YP, Huang LH, Hsu LL, et al. The family surrogates’ psy-chological experience of making a do-not-resuscitate decision for older relatives:a qualitative study[J]. Contemp Nurse, 2018, 54(2):195-207. DOI URL
[17]	Ortega AR, Ramírez E, Colmenero JM, et al. Negative affect,decision making,and attentional networks[J]. J Atten Disord, 2017, 21(3):247-253. DOI URL
[18]	Zhang BL, Shou YY. Immediate emotions and subjective stakes in risky decision-making under uncertainty[J]. Anxiety Stress Coping, 2022, 35(6):649-661. DOI URL
[19]	Oxland P, Foster N, Fiest KM, et al. Engaging patients and fa-milies to help research inform and advance patient and family-centered care in critical care medicine[J]. Crit Care Nurs Clin North Am, 2020, 32(2):211-226. DOI URL
[20]	Rosiello G, Larcher A, Montorsi F, et al. Renal cancer:overdia-gnosis and overtreatment[J]. World J Urol, 2021, 39(8):2821-2823. DOI
[21]	De Panfilis L, di Leo S, Peruselli C, et al. “I go into crisis when…”:ethics of care and moral dilemmas in palliative care[J]. BMC Palliat Care, 2019, 18(1):70. DOI
[22]	Vega-Hurtado C. Importance of doctor-patient communication strategies[J]. Rev Med Inst Mex Seguro Soc, 2020, 58(2):197-201. DOI PMID
[23]	Mendyk AM, Labreuche J, Henon H, et al. Which factors in-fluence the resort to surrogate consent in stroke trials,and what are the patient outcomes in this context?[J]. BMC Med Ethics, 2015, 16:26. DOI URL
[24]	Kim H, Deatrick JA, Ulrich CM. Ethical frameworks for sur-rogates’ end-of-life planning experiences[J]. Nurs Ethics, 2017, 24(1):46-69. DOI URL
[25]	Currow DC, Agar MR, Phillips JL. Role of hospice care at the end of life for people with cancer[J]. J Clin Oncol, 2020, 38(9):937-943. DOI PMID
[26]	Hammami MM, Abuhdeeb K, Al Balkhi A. Importance hierar-chy of surrogate medical decision making determinants:a Q-me-thodology study in middle eastern and east Asian men[J]. Med Decis Making, 2020, 40(8):1020-1033. DOI URL
[27]	郭园丽, 杨彩侠, 郭丽娜, 等. 急性缺血性脑卒中溶栓代理决策者的决策困境及影响因素[J]. 中华护理杂志, 2023, 58(1):23-30. DOI
	Guo YL, Yang CX, Guo LN, et al. The decisional conflict and influence factors of proxies of patients with acute ischemic stroke in thrombolysis decision-making[J]. Chin J Nurs, 2023, 58(1):23-30. DOI