Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Crit Care Med. 2011 May;39(5):975-83. doi: 10.1097/CCM.0b013e31820a91db.
There are numerous challenges to successfully integrating palliative care in the intensive care unit. Our primary goal was to describe and compare the quality of palliative care delivered in an intensive care unit as rated by physicians and nurses working in that intensive care unit.
Multisite study using self-report questionnaires.
Thirteen hospitals throughout the United States.
Convenience sample of 188 physicians working in critical care (attending physicians, critical care fellows, resident physicians) and 289 critical care nurses.
Clinicians provided overall ratings of the care delivered by either nurses or physicians in their intensive care unit for each of seven domains of intensive care unit palliative care using a 0-10 scale (0 indicating the worst possible and 10 indicating the best possible care). Analyses included descriptive statistics to characterize measurement characteristics of the ten items, paired Wilcoxon tests comparing item ratings for the domain of symptom management with all other item ratings, and regression analyses assessing differences in ratings within and between clinical disciplines. We used p < .001 to denote statistical significance to address multiple comparisons. The ten items demonstrated good content validity with few missing responses or ceiling or floor effects. Items receiving the lowest ratings assessed spiritual support for families, emotional support for intensive care unit clinicians, and palliative-care education for intensive care unit clinicians. All but two items were rated significantly lower than the item assessing symptom management (p < .001). Nurses rated nursing care significantly higher (p < .001) than physicians rated physician care in five domains. In addition, although nurses and physicians gave comparable ratings to palliative care delivered by nurses, nurses' and physicians' ratings of physician care were significantly different with nurse ratings of this care lower than physician ratings on all but one domain.
Our study supports the content validity of the ten overall rating items and supports the need for improvement in several aspects of palliative care, including spiritual support for families, emotional support for clinicians, and clinician education about palliative care in the intensive care unit. Furthermore, our findings provide some preliminary support for surveying intensive care unit clinicians as one way to assess the quality of palliative care in the intensive care unit.
成功将姑息治疗融入重症监护病房存在诸多挑战。我们的主要目标是描述和比较在重症监护病房工作的医生和护士对重症监护病房姑息治疗质量的评价。
使用自我报告问卷的多站点研究。
美国 13 家医院。
便利抽样的 188 名重症监护医生（主治医生、重症监护研究员、住院医生）和 289 名重症监护护士。
临床医生对每个重症监护病房姑息治疗的七个领域的护理提供了整体评分，使用 0-10 分制（0 表示最差，10 表示最好）。分析包括描述性统计，以描述十个项目的测量特征，配对的 Wilcoxon 检验比较症状管理领域的项目评分与所有其他项目评分，以及回归分析评估临床学科内和学科间评分的差异。我们使用 p <.001 表示统计学意义，以解决多次比较的问题。十个项目具有良好的内容有效性，很少有缺失的回答或天花板或地板效应。得分最低的项目评估了对家庭的精神支持、对重症监护病房临床医生的情感支持以及对重症监护病房临床医生的姑息治疗教育。除了两个项目外，所有项目的评分都明显低于评估症状管理的项目（p <.001）。护士对护理的评分显著高于（p <.001）医生对医生护理的评分，在五个领域中。此外，尽管护士和医生对护士提供的姑息治疗给予了相似的评分，但护士和医生对医生护理的评分存在显著差异，除了一个领域外，护士对该护理的评分均低于医生。
我们的研究支持十个总体评分项目的内容有效性，并支持需要改进姑息治疗的几个方面，包括对家庭的精神支持、对临床医生的情感支持以及重症监护病房临床医生对姑息治疗的教育。此外，我们的研究结果为调查重症监护病房临床医生提供了一些初步支持，这是评估重症监护病房姑息治疗质量的一种方法。
