Mello Michelle M, Burns Jeffrey P, Truog Robert D, Studdert David M, Puopolo Ann Louise, Brennan Troyen A
Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA.
Pediatr Crit Care Med. 2004 Jan;5(1):40-7. doi: 10.1097/01.PCC.0000102413.32891.E5.
To facilitate critical decision making and improve satisfaction with care among families of patients in a pediatric intensive care unit.
Prospective observational study followed by a nonrandomized controlled trial of a clinical intervention to identify conflicts and facilitate communication between families and the clinical team.
The pediatric intensive care unit of a Boston teaching hospital.
A total of 127 patients receiving care in the pediatric intensive care unit in 1998-1999 and their families.
Interviews were conducted with surrogates and decisionally capable older children concerning the adequacy of information provided, understanding, communication, and perceived decisional conflicts. Findings were relayed to the clinical team, who then developed tailored follow-up recommendations.
A survey administered to surrogates at baseline and day 7 or intensive care unit discharge measured satisfaction with care. Information on patient acuity and hospital stay were extracted from medical records and hospital databases. Wilcoxon rank-sum tests and incidence rate comparisons were used to assess the impact of the intervention on satisfaction and sentinel decision making, respectively. Incidence rates of care plan decision making, including decisions to adopt a comfort-care-only plan and decisions to forego resuscitation, were lower among families who received the intervention. The intervention did not significantly affect satisfaction with care.
Prospectively screening for and intervening to mitigate potential conflict did not increase decision making or parental satisfaction with the care provided in this pediatric intensive care unit.
促进儿科重症监护病房患者家属进行关键决策并提高其对医疗护理的满意度。
前瞻性观察性研究，随后进行一项临床干预的非随机对照试验，以识别冲突并促进家属与临床团队之间的沟通。
波士顿一家教学医院的儿科重症监护病房。
1998 - 1999年在该儿科重症监护病房接受治疗的127名患者及其家属。
就所提供信息的充分性、理解情况、沟通情况以及感知到的决策冲突，与替代决策者和具备决策能力的大龄儿童进行访谈。将结果反馈给临床团队，然后由临床团队制定针对性的后续建议。
在基线时以及第7天或重症监护病房出院时对替代决策者进行的一项调查测量了对医疗护理的满意度。从病历和医院数据库中提取患者病情严重程度和住院时间的信息。分别使用Wilcoxon秩和检验和发病率比较来评估干预对满意度和关键决策的影响。接受干预的家庭中，护理计划决策的发生率较低，包括决定仅采取舒适护理计划以及决定放弃心肺复苏。该干预对医疗护理满意度没有显著影响。
前瞻性筛查并干预以减轻潜在冲突，并未增加该儿科重症监护病房的决策制定或家长对所提供护理的满意度。
