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有谁出席?重症监护病房的临终决策。

Who is attending? End-of-life decision making in the intensive care unit.

机构信息

School of Nursing, Oregon Health & Science University, Portland, Oregon 97239, USA.

出版信息

J Palliat Med. 2012 Jan;15(1):56-62. doi: 10.1089/jpm.2011.0307. Epub 2012 Jan 10.

Abstract

PURPOSE

Traditional expectations of the single attending physician who manages a patient's care do not apply in today's intensive care units (ICUs). Although many physicians and other professionals have adapted to the complexity of multiple attendings, ICU patients and families often expect the traditional, single physician model, particularly at the time of end-of-life decision making (EOLDM). Our purpose was to examine the role of ICU attending physicians in different types of ICUs and the consequences of that role for clinicians, patients, and families in the context of EOLDM.

METHODS

Prospective ethnographic study in a university hospital, tertiary care center. We conducted 7 months of observations including 157 interviews in each of four adult critical care units.

RESULTS

The term "attending physician" was understood by most patients and families to signify an individual accountable person. In practice, "the attending physician" was an ICU role, filled by multiple physicians on a rotating basis or by multiple physicians simultaneously. Clinicians noted that management of EOLDM varied in relation to these multiple and shifting attending responsibilities. The attending physician role in this practice context and in the EOLDM process created confusion for families and for some clinicians about who was making patient care decisions and with whom they should confer.

CONCLUSIONS

Any intervention to improve the process of EOLDM in ICUs needs to reflect system changes that address clinician and patient/family confusion about EOLDM roles of the various attending physicians encountered in the ICU.

摘要

目的

传统上,患者的护理由一位主治医生负责,但这种模式在现今的重症监护病房(ICU)已不再适用。尽管许多医生和其他专业人员已经适应了多位主治医生的复杂性,但 ICU 患者及其家属通常仍期望采用传统的单一主治医生模式,尤其是在进行临终决策(EOLDM)时。我们的目的是研究 ICU 主治医生在不同类型 ICU 中的角色,以及在 EOLDM 背景下,该角色对临床医生、患者和家属的影响。

方法

在一所大学医院、三级护理中心进行前瞻性民族志研究。我们进行了 7 个月的观察,在四个成人重症监护病房中,每个病房进行了 157 次访谈。

结果

大多数患者和家属理解“主治医生”一词是指一个负责的个体。实际上,“主治医生”是 ICU 的一个角色,由多名轮流值班的医生或多名同时值班的医生担任。临床医生指出,EOLDM 的管理与这些多位和不断变化的主治责任有关。在这种实践背景和 EOLDM 过程中,主治医生的角色使患者和一些临床医生感到困惑,不清楚谁在做出患者护理决策,以及应该与谁协商。

结论

任何旨在改善 ICU 中 EOLDM 流程的干预措施都需要反映系统的变化,以解决临床医生和患者/家属对 ICU 中遇到的不同主治医生在 EOLDM 角色方面的困惑。

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