Petriwskyj Andrea, Gibson Alexandra, Parker Deborah, Banks Susan, Andrews Sharon, Robinson Andrew
1The University of Queensland, Australian Centre for Evidence-Based Community Care and UQ/Blue Care Research and Practice Development Centre, Queensland 2Wicking Dementia Research and Education Centre, University of Tasmania, Australia.
Int J Evid Based Healthc. 2014 Jun;12(2):64-86. doi: 10.1097/XEB.0000000000000003.
Ensuring older adults' involvement in their care is accepted as good practice and is vital, particularly for people with dementia, whose care and treatment needs change considerably over the course of the illness. However, involving family members in decision making on people's behalf is still practically difficult for staff and family. The aim of this review was to identify and appraise the existing quantitative evidence about family involvement in decision making for people with dementia living in residential aged care.
The present Joanna Briggs Institute (JBI) metasynthesis assessed studies that investigated involvement of family members in decision making for people with dementia in residential aged care settings. While quantitative and qualitative studies were included in the review, this paper presents the quantitative findings. A comprehensive search of 15 electronic databases was performed. The search was limited to papers published in English, from 1990 to 2013. Twenty-six studies were identified as being relevant; 10 were quantitative, with 1 mixed method study. Two independent reviewers assessed the studies for methodological validity and extracted the data using the JBI Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). The findings were synthesized and presented in narrative form.
The findings related to decisions encountered and made by family surrogates, variables associated with decisions, surrogates' perceptions of, and preferences for, their roles, as well as outcomes for people with dementia and their families.
The results identified patterns within, and variables associated with, surrogate decision making, all of which highlight the complexity and variation regarding family involvement. Attention needs to be paid to supporting family members in decision making in collaboration with staff.
确保老年人参与自身护理被视为良好做法且至关重要，对于痴呆症患者而言尤其如此，因为他们的护理和治疗需求在疾病过程中会发生很大变化。然而，让工作人员和家庭成员代表患者参与决策在实际操作中仍存在困难。本综述的目的是识别和评估现有的关于居住在老年护理机构中的痴呆症患者家庭参与决策的定量证据。
当前的乔安娜·布里格斯研究所（JBI）综合分析评估了调查家庭成员参与居住在老年护理机构中的痴呆症患者决策情况的研究。虽然综述纳入了定量和定性研究，但本文呈现的是定量研究结果。对15个电子数据库进行了全面检索。检索仅限于1990年至2013年以英文发表的论文。确定了26项相关研究；其中10项为定量研究，1项为混合方法研究。两名独立评审员评估研究的方法学有效性，并使用JBI统计评估与综述工具（JBI-MAStARI）提取数据。研究结果以叙述形式进行了综合和呈现。
研究结果涉及家庭代理人遇到和做出的决策、与决策相关的变量、代理人对其角色的认知和偏好，以及痴呆症患者及其家庭的结果。
结果确定了代理人决策中的模式以及与之相关的变量，所有这些都凸显了家庭参与的复杂性和多样性。需要关注支持家庭成员与工作人员合作进行决策。
