Bern-Klug Mercedes
a School of Social Work , University of Iowa , Iowa City , Iowa , USA.
J Soc Work End Life Palliat Care. 2014;10(1):59-79. doi: 10.1080/15524256.2013.877863.
An increasing proportion of dying is occurring in America's nursing homes (NH). Family members are involved in (and affected by) medical decision-making on behalf of NH residents approaching the end of life, especially when the resident is cognitively impaired. This article proposes an empirically derived conceptual model of the key factors NH family surrogate decision-makers consider when establishing or changing goals of care and the iterative process as applied to the NH setting. This model also establishes the importance of family social role expectations toward their loved one as well as the concept, "stance toward dying," as key in establishing or changing the main goal of care. NH staff and physicians can use the model as a framework for providing information and support to family members. Research is needed to better understand how to prepare staff and settings to support family surrogate decision-makers, in particular around setting goals of care. The model can be generalized beyond nursing homes.
在美国，越来越多的人在养老院中离世。家庭成员会参与（并受其影响）代表临近生命终点的养老院居民做出医疗决策，尤其是当居民存在认知障碍时。本文提出了一个基于实证得出的概念模型，该模型涉及养老院家庭替代决策者在确立或改变护理目标时所考虑的关键因素，以及应用于养老院环境的迭代过程。此模型还确立了家庭对其亲人的社会角色期望的重要性，以及“面对死亡的态度”这一概念在确立或改变主要护理目标时的关键作用。养老院工作人员和医生可以将该模型用作向家庭成员提供信息和支持的框架。需要开展研究，以更好地了解如何让工作人员和环境做好准备，以支持家庭替代决策者，特别是在设定护理目标方面。该模型可推广至养老院之外的场景。
