Intensive Care Department, Sir Charles Gairdner Hospital, Level 4 G Block, Hospital Ave, Nedlands, Perth, WA, 6009, Australia.
School of Public Health, Curtin University, Perth, WA, Australia.
Patient. 2020 Jun;13(3):339-346. doi: 10.1007/s40271-020-00410-1.
Many patients in the intensive care unit are too unwell to participate in shared decision making or have not previously documented their wishes. In these situations, understanding the values of the general population could help doctors provide appropriate guidance to surrogate decision makers.
Using a discrete choice experiment design, we conducted an online survey using an Australian panel. Participants were asked about their willingness to accept treatments, faced with a variety of possible outcomes and probabilities (low, moderate or high). The outcomes were across four domains: loss of functional autonomy, pain, cognitive disability and degree of burden on others. Demographic details, prior experience of intensive care unit and current health conditions were also collected. Data were analysed using logistic regression, predicting whether respondents choose to continue active treatment or not.
Nine hundred and eighty-four respondents, representative of age and sex completed the web-based survey. With the increasing likelihood of negative post-intensive care unit sequelae, there was a higher probability of the respondent preferring to stop ongoing active treatment, with the largest coefficients being on caring assistance and the need for full-time residential care. Those who identified as very religious, were younger or who had children under 5 years of age were more likely to choose to continue active treatment.
Respondents valued their independence as the most important factor in deciding whether to receive ongoing medical treatments in the intensive care unit. When clinicians are unable to obtain specific patient information, they should consider framing their decision making around the likelihood of the patient achieving functional independence rather than survival.
许多重症监护病房的患者身体状况不佳，无法参与共同决策，或者之前没有记录过自己的意愿。在这些情况下，了解普通人群的价值观可以帮助医生为替代决策人提供适当的指导。
我们采用离散选择实验设计，使用澳大利亚的在线面板进行了一项在线调查。参与者被要求在面临各种可能的结果和概率（低、中或高）的情况下，接受或拒绝治疗。结果涉及四个领域：功能自主性丧失、疼痛、认知障碍和对他人的负担程度。还收集了人口统计学细节、重症监护病房的先前经历和当前健康状况。使用逻辑回归分析数据，预测受访者是否选择继续进行积极治疗。
984 名代表性年龄和性别的受访者完成了在线调查。随着重症监护后负面后果的可能性增加，受访者更有可能选择停止正在进行的积极治疗，最大的系数是在护理援助和需要全职住院护理方面。那些认为自己非常虔诚、年龄较小或有 5 岁以下子女的人更有可能选择继续积极治疗。
受访者将独立视为决定是否在重症监护室接受持续医疗治疗的最重要因素。当临床医生无法获得特定患者信息时，他们应该考虑围绕患者实现功能独立的可能性而不是生存的可能性来制定决策。
