George Naomi R, Kryworuchko Jennifer, Hunold Katherine M, Ouchi Kei, Berman Amy, Wright Rebecca, Grudzen Corita R, Kovalerchik Olga, LeFebvre Eric M, Lindor Rachel A, Quest Tammie E, Schmidt Terri A, Sussman Tamara, Vandenbroucke Amy, Volandes Angelo E, Platts-Mills Timothy F
Department of Emergency Medicine, Brown University, Providence, RI.
University of British Columbia, Vancouver, British Columbia, Canada.
Acad Emerg Med. 2016 Dec;23(12):1394-1402. doi: 10.1111/acem.13083. Epub 2016 Nov 25.
Little is known about the optimal use of shared decision making (SDM) to guide palliative and end-of-life decisions in the emergency department (ED).
The objective was to convene a working group to develop a set of research questions that, when answered, will substantially advance the ability of clinicians to use SDM to guide palliative and end-of-life care decisions in the ED.
Participants were identified based on expertise in emergency, palliative, or geriatrics care; policy or patient-advocacy; and spanned physician, nursing, social work, legal, and patient perspectives. Input from the group was elicited using a time-staggered Delphi process including three teleconferences, an open platform for asynchronous input, and an in-person meeting to obtain a final round of input from all members and to identify and resolve or describe areas of disagreement.
Key research questions identified by the group related to which ED patients are likely to benefit from palliative care (PC), what interventions can most effectively promote PC in the ED, what outcomes are most appropriate to assess the impact of these interventions, what is the potential for initiating advance care planning in the ED to help patients define long-term goals of care, and what policies influence palliative and end-of-life care decision making in the ED. Answers to these questions have the potential to substantially improve the quality of care for ED patients with advanced illness.
关于如何最佳地运用共同决策（SDM）来指导急诊科（ED）的姑息治疗和临终决策，目前所知甚少。
目标是召集一个工作组，以制定一系列研究问题，一旦这些问题得到解答，将极大地提升临床医生运用共同决策来指导急诊科姑息治疗和临终护理决策的能力。
根据在急诊、姑息或老年护理方面的专业知识；政策或患者倡导方面的专业知识来确定参与者；参与者涵盖医生、护士、社会工作者、法律专业人士以及患者的视角。通过一个时间错开的德尔菲法来收集该小组的意见，包括三次电话会议、一个用于异步输入的开放平台以及一次面对面会议，以获取所有成员的最后一轮意见，并识别和解决或描述存在分歧的领域。
该小组确定的关键研究问题涉及哪些急诊科患者可能从姑息治疗（PC）中受益、哪些干预措施能最有效地在急诊科促进姑息治疗、评估这些干预措施的影响最适合采用哪些结果、在急诊科启动预先护理计划以帮助患者确定长期护理目标的可能性有多大，以及哪些政策影响急诊科的姑息治疗和临终护理决策。这些问题的答案有可能显著提高患有晚期疾病的急诊科患者的护理质量。
