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, Australia 2Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia.
Int J Evid Based Healthc. 2014 Jun;12(2):87-104. doi: 10.1097/XEB.0000000000000002.
Involving people in decisions about their care is good practice and ensures optimal outcomes. Despite considerable research, in practice family involvement in decision making can be challenging for both care staff and families. The aim of this review was to identify and appraise existing knowledge about family involvement in decision making for people with dementia living in residential aged care.
The present Joanna Briggs Institute meta-synthesis considered studies that investigate 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 article presents the qualitative findings. A comprehensive search of studies was conducted in 15 electronic databases. The search was limited to papers published in English, from 1990 to 2013. Twenty-six studies were identified as relevant for this review; 16 were qualitative papers reporting on 15 studies. Two independent reviewers assessed the studies for methodological validity and extracted the data using the standardized Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). The findings were synthesized using JBI-QARI.
The findings related to the decisions encountered and made by family surrogates, family perceptions of, and preferences for, their role/s, factors regarding treatment decisions and the collaborative decision-making process, and outcomes for family decision makers.
Results indicate varied and complex experiences and multiple factors influencing decision making. Communication and contacts between staff and families and the support available for families should be addressed, as well as the role of different stakeholders in decisions.
让人们参与有关其护理的决策是良好的做法，并能确保实现最佳结果。尽管有大量研究，但在实际操作中，家庭参与决策对护理人员和家庭来说都可能具有挑战性。本综述的目的是识别和评估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现有知识。
乔安娜·布里格斯研究所（Joanna Briggs Institute）目前的综合分析纳入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，但本文呈现的是定性研究结果。在15个电子数据库中对研究进行了全面检索。检索仅限于1990年至2013年以英文发表的论文。确定了26项与本综述相关的研究；其中16篇是定性论文，报告了15项研究。两名独立评审员评估了研究的方法学有效性，并使用标准化的乔安娜·布里格斯研究所定性评估与综述工具（JBI-QARI）提取数据。研究结果使用JBI-QARI进行了综合分析。
研究结果涉及家庭代理人遇到并做出的决策、家庭对其角色的认知和偏好、与治疗决策及协作决策过程相关的因素，以及家庭决策者的结果。
结果表明，决策过程中的经历多样且复杂，有多种因素影响决策。应关注工作人员与家庭之间的沟通与联系、为家庭提供的支持，以及不同利益相关者在决策中的作用。
