神经重症监护病房临床医生对无效医疗照护的认知。

Perception of Provision of Futile Care Among Clinicians in the Neuroscience Intensive Care Unit.

机构信息

Shanna Amoroso, ACNP, is Nurse Practitioner in the Department of Neurosurgery at the Medical University of South Carolina, Charleston, SC.

出版信息

J Neurosci Nurs. 2019 Oct;51(5):249-252. doi: 10.1097/JNN.0000000000000462.

DOI:10.1097/JNN.0000000000000462

PMID:31469702

Abstract

BACKGROUND

Futile care in the neuroscience intensive care unit (NSICU) can create moral distress for clinicians who may differ in their interpretation of the value of such care. We sought to compare the perception of provision of futile care in the NSICU among physicians, advanced practice providers, and intensive care unit registered nurses (ICURNs).

METHODS

This is a cross-sectional study of 77 patients. A standardized questionnaire was used to ask clinicians whether care being provided to NSICU patients admitted for more than 48 hours was futile and whether they would want that treatment for their loved one. Demographics, diagnosis, and reason for treatment futility were collected. Futility was analyzed independently and in an aggregate manner (yes/probable combined and no/probable combined).

RESULTS

The sample median age was 61 (SD, 17.179) years, men comprised 53% of the sample, and 68% were white. Collectively, there were 77 futile responses (33%), 136 nonfutile (59%), and 18 probable futile (8%). Physicians and nurse practitioners deemed futility in 36% of patients; ICURNs, in 27% (P < .05). Age, race, or diagnosis did not impact futility perception. The treatment was acceptable for a loved one in 53% of cases for physicians, 43% for advanced practice providers, and 48% for ICURNs (P < .05). Interobserver agreement for futility was 0.469 (CK), and pairwise agreement was 71%. Interobserver agreement for treatment acceptable for a loved one was 0.568 (CK), and pairwise agreement was 78%.

CONCLUSIONS

Clinicians consider NSICU care futile in one-third of patients, but correlation among them is moderate; no specific variable is associated with such perception.

摘要

背景

神经重症监护病房（NSICU）的无效治疗可能会给临床医生带来道德困境，因为他们对这种治疗的价值可能存在不同的理解。我们旨在比较医生、高级执业医师和重症监护病房注册护士（ICURNs）对 NSICU 中无效治疗的看法。

方法

这是一项对 77 名患者的横断面研究。使用标准化问卷询问临床医生，他们正在为在 NSICU 住院超过 48 小时的患者提供的治疗是否无效，以及他们是否希望为自己的亲人接受这种治疗。收集了人口统计学、诊断和治疗无效的原因。无效性分析采用独立和综合两种方法（是/可能和否/可能合并）。

结果

样本的中位数年龄为 61 岁（标准差为 17.179 岁），男性占 53%，白人占 68%。共有 77 例无效（33%）、136 例非无效（59%）和 18 例可能无效（8%）。医生和护士从业者认为 36%的患者存在无效性；而 ICURNs 认为 27%的患者存在无效性（P<.05）。年龄、种族或诊断并不影响无效性的感知。对于医生来说，有 53%的情况下治疗是可以接受的；对于高级执业医师来说，有 43%的情况下治疗是可以接受的；对于 ICURNs 来说，有 48%的情况下治疗是可以接受的（P<.05）。对于无效性的观察者间一致性为 0.469（CK），两两一致性为 71%。对于治疗对亲人是可以接受的，观察者间一致性为 0.568（CK），两两一致性为 78%。