Lautrette Alexandre, Ciroldi Magali, Ksibi Hichem, Azoulay Elie
FAMIREA Study Group, Medical Intensive Care Unit, AP-HP, Saint-Louis Teaching Hospital and Paris 7 University, France.
Crit Care Med. 2006 Nov;34(11 Suppl):S364-72. doi: 10.1097/01.CCM.0000237049.44246.8C.
Critical care clinicians no longer consider family members as visitors in the intensive care unit. Family-centered care has emerged from the results of qualitative and quantitative studies evaluating the specific needs of families of patients dying in the intensive care unit. In addition, interventional studies have established that intensive and proactive communication empowers family members of dying patients, helping them to share in discussions and decisions, if they so wish. In addition to intensive communication, interventional studies have highlighted the role of nurses, social workers, and palliative care teams in reducing family burden, avoiding futile life-sustaining therapies, and providing effective comfort care. End-of-life family conferences are formal, structured meetings between intensivists and family members. Guidelines for organizing these conferences take into account the specific needs of families, including reassurance that the patient's symptoms will be adequately managed; honest clear information about the patient's condition and treatment; a willingness on the part of physicians to listen and respond to family members and to address their emotions; attention to patient preferences; clear explanations about surrogate decision making; and continuous, compassionate, and technically proficient attention to the patient's needs until death occurs. Means of improving end-of-life care have been identified in epidemiologic and interventional studies. End-of-life family conferences constitute the keystone around which excellent end-of-life care can be built.
重症监护临床医生不再将家庭成员视为重症监护病房的访客。以家庭为中心的护理源于对在重症监护病房死亡患者家属具体需求进行评估的定性和定量研究结果。此外，干预性研究表明，深入且积极主动的沟通能赋予濒死患者家属权力，若他们愿意，可帮助他们参与讨论和决策。除了深入沟通，干预性研究还凸显了护士、社会工作者和姑息治疗团队在减轻家庭负担、避免无效的维持生命治疗以及提供有效的舒适护理方面的作用。临终家庭会议是重症监护医生与家庭成员之间正式、结构化的会议。组织这些会议的指南考虑到了家庭的具体需求，包括确保患者的症状能得到充分控制；提供关于患者病情和治疗的真实、清晰信息；医生愿意倾听并回应家庭成员，关注他们的情绪；关注患者的偏好；清楚解释替代决策制定；以及在患者死亡前持续、富有同情心且专业地关注患者需求。在流行病学和干预性研究中已确定了改善临终护理的方法。临终家庭会议是构建优质临终护理的基石。
