共享决策在ICU中的应用进展

doi:10.3761/j.issn.0254-1769.2021.02.023

摘要/Abstract

摘要：

共享决策作为“以患者为中心的护理”的核心,是医患之间通过参考现有的最佳临床证据并考虑患者的价值观和偏好,协同合作制订决策的过程。共享决策通过促进患方参与决策,并增强其对预后和治疗护理措施的理解,来制订更加明智的决策。该文介绍共享决策在ICU的实施意义及应用情况,针对患者/家属因素、医疗相关人员因素和评估工具因素3个方面的影响因素进行分析,提出了共享决策在ICU实施的建议,以期为共享决策在ICU中的应用提供参考。

关键词: 共享决策, 重症监护病房, 决策辅助, 护理

Abstract:

Shared decision-making,the core in patient-centered care,is a collaborative decision-making process between healthcare providers and patients or their surrogates,taking into account the best available scientific evi-dence,while considering the patient’s values,goals and preferences. Shared decision-making helps patients or their surrogates formulate more informed decisions through active participation in the decision and enhanced unders-tanding of prognosis,various treatment and nursing interventions. In order to provide references for the application of shared decision-making in ICU,this article introduces significances and applications of shared decision-making in ICU,analyzes the influencing factors from 3 aspects including patients,healthcare providers and assessment tools,and proposes suggestions for the application of shared decision-making in the ICU.

Key words: Shared Decision-Making, Intensive Care Units, Decision Aid, Nursing Care

朱懿珍, 张爽, 关玉珠, 孟萌, 李乐之. 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 Yizhen, ZHANG Shuang, GUAN Yuzhu, MENG Meng, LI Lezhi. Application progress of shared decision-making in ICU[J]. Chinese Journal of Nursing, 2021, 56(2): 289-294.

参考文献 35

[1]	Cameron JI, Chu LM, Matte A , et al. One-year outcomes in care-givers of critically ill patients[J]. N Engl J Med, 2016,374(19):1831-1841.
[2]	Miller JJ, Morris P, Files DC , et al. Decision conflict and regret among surrogate decision makers in the medical intensive care unit[J]. J Crit Care, 2016,32:79-84.
[3]	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.
[4]	Azoulay E, Chevret S, Leleu G , et al. Half the families of intensive care unit patients experience inadequate communication with physicians[J]. Crit Care Med, 2000,28(8):3044-3049.
[5]	Charles C, Gafni A, Whelan T . Shared decision-making in the medical encounter:what does it mean?(or it takes at least two to tango)[J]. Soc Sci Med, 1997,44(5):681-692.
[6]	Kon AA, Davidson JE, Morrison W , et al. Shared decision-making in ICUs:an American college of critical care medicine and American thoracic society policy statement[J]. Crit Care Med, 2016,44(1):188-201.
[7]	伍松柏, 吕爱莲 . “共同决策模式”在ICU医患沟通中的应用价值[J]. 医学与哲学, 2019,40(6):25-27,77.
	Wu SB, Lü AL . Application value of shared decision-making on doctor-patient communication in ICU[J]. Med Philos, 2019,40(6):25-27,77.
[8]	郑红颖, 胡嘉乐, 董柏君 , 等. 医患共享决策评估工具的研究进展[J]. 中华护理杂志, 2018,53(5):622-625.
	Zheng HY, Hu JL, Dong BJ , et al. Research progress and evaluation of assessment tools for shared decision making[J]. Chin J Nurs, 2018,53(5):622-625.
[9]	曹琴琴, 张宗侠, 王西鸽 , 等. 共享决策在急诊心血管疾病护理中的应用进展[J]. 中华护理杂志, 2019,54(4):595-598.
	Cao QQ, Zhang ZX, Wang XG , et al. Shared decision making in emergency nursing of cardiovascular disease: a review[J]. Chin J Nurs, 2019,54(4):595-598.
[10]	吴菲霞, 庄一渝, 陈香萍 , 等. ICU患者家属参与决策的现况研究[J]. 临床荟萃, 2020,35(1):67-71.
	Wu FX, Zhuang YY, Chen XP , et al. Involvement of family members of ICU patients in decision making process:a cross-sectional study[J]. Clin Focus, 2020,35(1):67-71.
[11]	Barry MJ, Edgman-Levitan S . Shared decision making:pinnacle of patient-centered care[J]. N Engl J Med, 2012,366(9):780-781.
[12]	Elwyn G, Frosch DL, Kobrin S . Implementing shared decision-making:consider all the consequences[J]. Implement Sci, 2016,11:114.
[13]	Stacey D, Légaré F, Lewis K , et al. Decision aids for people facing health treatment or screening decisions[J]. Cochrane Database Syst Rev, 2017,4:D1431.
[14]	Kryworuchko J, Hill E, Murray MA , et al. Interventions for shared decision-making about life support in the intensive care unit:a systematic review[J]. Worldviews Evid Based Nurs, 2013,10(1):3-16.
[15]	Cox CE, White DB, Hough CL , et al. Effects of a personalized web-based decision aid for surrogate decision makers of patients with prolonged mechanical ventilation:a randomized clinical trial[J]. Ann Intern Med, 2019,170(5):285-297.
[16]	Allen SR, Pascual J, Martin N , et al. A novel method of optimizing patient- and family-centered care in the ICU[J]. J Trau-ma Acute Care Surg, 2017,82(3):582-586.
[17]	Kon AA . The shared decision-making continuum[J]. JAMA, 2010,304(8):903.
[18]	Stiggelbout AM, Pieterse AH, De Haes JC . Shared decision mak-ing:concepts,evidence,and practice[J]. Patient Educ Couns, 2015,98(10):1172-1179.
[19]	Curtis JR . The use of informed assent in withholding car-diopulmonary resuscitation in the ICU[J]. Virtual Mentor, 2012,14(7):545-550.
[20]	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.
[21]	Benoit DD, Jensen HI, Malmgren J , et al. Outcome in patients perceived as receiving excessive care across different ethical climates:a prospective study in 68 intensive care units in Europe and the USA[J]. Intensive Care Med, 2018,44(7):1039-1049.
[22]	Michalsen A, Long AC, DeKeyser Ganz F, et al. Interprofessional shared decision-making in the ICU:a systematic review and recommendations from an expert panel[J]. Crit Care Med, 2019,47(9):1258-1266.
[23]	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.
[24]	李玉, 叶志霞, 刘佩玉 , 等. 癌症患者治疗决策辅助的研究进展[J]. 中华护理杂志, 2017,52(1):28-33.
	Li Y, Ye ZX, Liu PY , et al. Research progress of decision aids in cancer patients’ treatment[J]. Chin J Nurs, 2017,52(1):28-33.
[25]	Cox CE, Lewis CL, Hanson LC , et al. Development and pilot testing of a decision aid for surrogates of patients with prolonged mechanical ventilation[J]. Crit Care Med, 2012,40(8):2327-2334.
[26]	Stacey D, Murray MA, Légaré F , et al. Decision coaching to support shared decision making:a framework,evidence,and implications for nursing practice,education,and policy[J]. Wor-ldviews Evid Based Nurs, 2008,5(1):25-35.
[27]	Berger-Höger B, Liethmann K, Mühlhauser I , et al. Nurse-led coaching of shared decision-making for women with ductal carcinoma in situ in breast care centers:a cluster randomized controlled trial[J]. Int J Nurs Stud, 2019,93:141-152.
[28]	Stacey D, Kryworuchko J, Bennett C , et al. Decision coaching to prepare patients for making health decisions:a systematic review of decision coaching in trials of patient decision AIDS[J]. Med Decis Making, 2012,32(3):E22-E33.
[29]	Joseph-Williams N, Elwyn G, Edwards A . Knowledge is not power for patients:a systematic review and thematic synjournal of patient-reported barriers and facilitators to shared decision making[J]. Patient Educ Couns, 2014,94(3):291-309.
[30]	Nelson JE, Hanson LC, Keller KL , et al. The voice of surrogate decision-makers. Family responses to prognostic informa-tion in chronic critical illness[J]. Am J Respir Crit Care Med, 2017,196(7):864-872.
[31]	Gärtner FR, Bomhof-Roordink H, Smith IP , et al. The quality of instruments to assess the process of shared decision making:a systematic review[J]. PLoS One, 2018,13(2):e191747.
[32]	王燕, 王小媛, 石立元 , 等. 乳腺癌乳房再造手术患者决策辅助方案的构建及应用[J]. 中华护理杂志, 2020,55(1):90-95.
	Wang Y, Wang XY, Shi LY , et al. Development and application of decision aid of breast reconstruction surgery among breast cancer patients[J]. Chin J Nurs, 2020,55(1):90-95.
[33]	王露, 陈英, 崔金锐 , 等. 直肠癌术式患者决策辅助方案的制订及应用研究[J]. 中华护理杂志, 2019,54(3):338-343.
	Wang L, Chen Y, Cui JR , et al. Development of rectal cancer surgery decision aid and its application in decision making among rectal cancer patients[J]. Chin J Nurs, 2019,54(3):338-343.
[34]	赵羚谷, 许卫卫, 王颖 , 等. 我国临床实践中的医患共同决策流程设计和挑战[J]. 医学与哲学, 2019,40(18):1-6.
	Zhao LG, Xu WW, Wang Y , et al. Process design and challenge of shared decision-making in clinical practice in China[J]. Med Philos, 2019,40(18):1-6.
[35]	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.