Trauma Center and Intensive Care Unit, Emergency Department, S. Camillo-C. Forlanini Hospitals, Rome, Italy.
Minerva Anestesiol. 2011 Sep;77(9):911-20.
Most patients in the ICU are unable to make decisions for themselves at the end of life (EOL), and the responsibility for these decisions falls to the medical staff and patients' relatives. Therefore, clinicians must frequently communicate with patients' relatives to understand the patients' values and preferences as they perform medical decision making. The family's role in this process varies: the entire burden of decision making could rest with the family, or family members could be informed of the decisions without admission into the decision-making process. In contrast to these two extremes, clinicians and family members may also enter into shared decision making: an exchange of views and opinions between clinicians and the patient's family to enable the two parties to reach decisions together. In this latter scenario, the effectiveness of the discussions that take place between clinicians and family members becomes a crucial marker of high-quality intensive care. In this review, we provide an overview of the current literature concerning the state of EOL care in European and Italian ICUs and then summarize several European and American recommendations for improving EOL care in the ICU. Finally, we examine the opportunity to use shared decision making to improve EOL care in the ICU through interdisciplinary communication, open and realistic discussion of prognosis with families, and an approach respecting different cultural perspectives.
大多数 ICU 患者在生命末期（EOL）无法为自己做出决策，这些决策的责任落在医务人员和患者家属身上。因此，临床医生必须经常与患者家属沟通，了解患者的价值观和偏好，以便在进行医疗决策时做出决策。在这个过程中，家庭的角色各不相同：决策的全部负担可能由家庭承担，或者可以在不参与决策过程的情况下向家属告知决策。与这两个极端相反，临床医生和家庭成员也可能参与共同决策：临床医生和患者家属之间交换意见和观点，使双方能够共同做出决策。在后一种情况下，临床医生和家属之间进行的讨论的有效性成为高质量重症监护的关键标志。在这篇综述中，我们概述了欧洲和意大利 ICU 中 EOL 护理的现状，然后总结了一些欧洲和美国改善 ICU 中 EOL 护理的建议。最后，我们探讨了通过跨学科沟通、与家属公开和现实地讨论预后以及尊重不同文化观点的方法，利用共同决策来改善 ICU 中 EOL 护理的机会。
