Case Western Reserve University, Cleveland, OH, USA.
Crit Care Med. 2012 Feb;40(2):461-7. doi: 10.1097/CCM.0b013e318232d8c4.
To examine the frequency with which quality of life and treatment limitation were discussed in formal family meetings for long-stay intensive care unit patients with high risk for mortality and morbidity.
Descriptive observational study.
Five intensive care units.
One hundred sixteen family surrogate decisionmakers of long-stay intensive care unit patients who participated in an intensive communication system that aimed to provide weekly meetings with family decisionmakers. The structure of each meeting was to address medical update, patient preferences, treatment plan, and milestones for evaluating the treatment plan.
None.
We audiotaped initial family meetings for 116 family decisionmakers for a total of 180 meetings. On average, meetings were 24 mins long with a majority of time being devoted to nonemotional speech and little (12%) spent discussing patient preferences. Quality of life was discussed in 45% and treatment limitation in 23% of all meetings. Quality-of-life discussions were more likely to occur when patients were admitted to a medical intensive care unit (odds ratio [OR] 5.9; p = .005), have a family decisionmaker who is a spouse (OR 9.4; p = .0001), were older (OR 1.04; p = 01), have a shorter length of stay (OR 0.93; p = .001), and have a family decisionmaker who was a spouse (OR 5.1; p = .002). For those with a treatment limitation discussion, 67% had a do-not-resuscitate order, 40% were admitted to a medical intensive care unit, 56% had a family decisionmaker who had been their caregiver, and 48% of their family decisionmakers were their children.
To guide discussion with families of the subset of intensive care unit patients with high risk of mortality and long-term morbidity, quality of life was not consistently addressed. Continued efforts to assist clinicians in routinely including discussions of quality-of-life outcomes is needed.
调查在针对高死亡率和高发病率的长期重症监护病房患者进行的正式家庭会议中，讨论生活质量和治疗限制的频率。
描述性观察研究。
五家重症监护病房。
116 名长期重症监护病房患者的家属代理人参加了一项强化沟通系统，该系统旨在为家属决策者提供每周一次的会议。每次会议的结构是讨论医疗更新、患者偏好、治疗计划以及评估治疗计划的里程碑。
无。
我们对 116 名家属决策者的初始家庭会议进行了录音，共 180 次会议。平均而言，会议时长为 24 分钟，大部分时间用于非情感性演讲，只有很少的时间（12%）用于讨论患者偏好。在所有会议中，有 45%的会议讨论了生活质量，有 23%的会议讨论了治疗限制。当患者入住医疗重症监护病房时（比值比[OR] 5.9；p =.005）、家属决策者是配偶（OR 9.4；p =.0001）、年龄较大（OR 1.04；p = 01）、住院时间较短（OR 0.93；p = 001）、家属决策者是配偶（OR 5.1；p = 002）时，更有可能进行生活质量讨论。对于那些进行了治疗限制讨论的患者，67%的患者有不复苏医嘱，40%的患者入住医疗重症监护病房，56%的患者有曾是其护理人员的家属决策者，而 48%的患者家属决策者是他们的子女。
为了指导高死亡率和长期发病率重症监护病房患者的家属进行讨论，并未始终解决生活质量问题。需要继续努力帮助临床医生常规纳入生活质量结果的讨论。
