Division of Pulmonary, Critical Care, and Sleep Medicine, and Hertzberg Palliative Care Institute, Mount Sinai School of Medicine, New York, NY, USA.
Crit Care Med. 2010 Mar;38(3):808-18. doi: 10.1097/ccm.0b013e3181c5887c.
Although the majority of hospital deaths occur in the intensive care unit and virtually all critically ill patients and their families have palliative needs, we know little about how patients and families, the most important "stakeholders," define high-quality intensive care unit palliative care. We conducted this study to obtain their views on important domains of this care.
Qualitative study using focus groups facilitated by a single physician.
A 20-bed general intensive care unit in a 382-bed community hospital in Oklahoma; 24-bed medical-surgical intensive care unit in a 377-bed tertiary, university hospital in urban California; and eight-bed medical intensive care unit in a 311-bed Veterans' Affairs hospital in a northeastern city.
Randomly-selected patients with intensive care unit length of stay >=5 days in 2007 to 2008 who survived the intensive care unit, families of survivors, and families of patients who died in the intensive care unit.
None.
Focus group facilitator used open-ended questions and scripted probes from a written guide. Three investigators independently coded meeting transcripts, achieving consensus on themes. From 48 subjects (15 patients, 33 family members) in nine focus groups across three sites, a shared definition of high-quality intensive care unit palliative care emerged: timely, clear, and compassionate communication by clinicians; clinical decision-making focused on patients' preferences, goals, and values; patient care maintaining comfort, dignity, and personhood; and family care with open access and proximity to patients, interdisciplinary support in the intensive care unit, and bereavement care for families of patients who died. Participants also endorsed specific processes to operationalize the care they considered important.
Efforts to improve intensive care unit palliative care quality should focus on domains and processes that are most valued by critically ill patients and their families, among whom we found broad agreement in a diverse sample. Measures of quality and effective interventions exist to improve care in domains that are important to intensive care unit patients and families.
尽管大多数医院死亡发生在重症监护病房，几乎所有危重症患者及其家属都有姑息治疗需求，但我们对最重要的“利益相关者”——患者和家属如何定义高质量的重症监护病房姑息治疗知之甚少。本研究旨在了解他们对该护理重要领域的看法。
在俄克拉荷马州一家拥有 382 张床位的社区医院的 20 张床位的普通重症监护病房、加利福尼亚州一家拥有 377 张床位的三级大学医院的 24 张床位的内科-外科重症监护病房和东北部城市一家拥有 311 张床位的退伍军人事务医院的 8 张床位的内科重症监护病房中，使用由一名医生协助的焦点小组进行定性研究。
2007 年至 2008 年入住重症监护病房且生存时间≥5 天的随机选择患者、幸存者的家属以及在重症监护病房死亡的患者的家属。
无。
焦点小组主持人使用开放式问题和书面指南中的脚本探针。三位研究人员独立对会议记录进行编码，就主题达成共识。来自三个地点的九个焦点小组的 48 名参与者（15 名患者，33 名家属）提出了一个共同的高质量重症监护病房姑息治疗定义：临床医生及时、清晰且富有同情心的沟通；以患者的偏好、目标和价值观为重点的临床决策；维持患者舒适度、尊严和人格的患者护理；以及对患者家属开放和靠近患者、提供重症监护病房跨学科支持和对死亡患者家属提供丧亲关怀的家属护理。参与者还认可了具体的操作流程，以实现他们认为重要的护理。
提高重症监护病房姑息治疗质量的努力应侧重于危重症患者及其家属最看重的领域和流程，在这方面，我们在一个多样化的样本中发现了广泛的共识。存在衡量质量和有效的干预措施，可以改善重症监护病房患者和家属重视的领域的护理。
