Cai Xuemei, Robinson Jennifer, Muehlschlegel Susanne, White Douglas B, Holloway Robert G, Sheth Kevin N, Fraenkel Liana, Hwang David Y
Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA,
Neurocrit Care. 2015 Aug;23(1):131-41. doi: 10.1007/s12028-015-0149-2.
In the neuroscience intensive care unit (NICU), most patients lack the capacity to make their own preferences known. This fact leads to situations where surrogate decision makers must fill the role of the patient in terms of making preference-based treatment decisions, oftentimes in challenging situations where prognosis is uncertain. The neurointensivist has a large responsibility and role to play in this shared decision-making process. This review covers how NICU patient preferences are determined through existing advance care documentation or surrogate decision makers and how the optimum roles of the physician and surrogate decision maker are addressed. We outline the process of reaching a shared decision between family and care team and describe a practice for conducting optimum family meetings based on studies of ICU families in crisis. We review challenges in the decision-making process between surrogate decision makers and medical teams in neurocritical care settings, as well as methods to ameliorate conflicts. Ultimately, the goal of shared decision making is to increase knowledge amongst surrogates and care providers, decrease decisional conflict, promote realistic expectations and preference-centered treatment strategies, and lift the emotional burden on families of neurocritical care patients.
在神经科学重症监护病房（NICU），大多数患者缺乏表达自身偏好的能力。这一事实导致了这样的情况：在做出基于偏好的治疗决策时，通常是在预后不确定的具有挑战性的情况下，替代决策者必须充当患者的角色。神经重症监护医生在这一共同决策过程中肩负着重大责任并发挥着重要作用。本综述涵盖了如何通过现有的预先医疗记录或替代决策者来确定NICU患者的偏好，以及如何明确医生和替代决策者的最佳角色。我们概述了家庭与护理团队达成共同决策的过程，并基于对处于危机中的ICU家庭的研究，描述了开展最佳家庭会议的做法。我们回顾了神经重症监护环境中替代决策者与医疗团队之间决策过程中的挑战，以及缓解冲突的方法。最终，共同决策的目标是增加替代决策者和护理提供者的知识，减少决策冲突，促进现实的期望和以偏好为中心的治疗策略，并减轻神经重症监护患者家庭的情感负担。
