替代决策人角色冲突与 ICU 患者的心理压力症状。

Role Incongruence and Psychological Stress Symptoms in Substitute Decision Makers of Intensive Care Patients.

机构信息

About the Authors: Orla M. Smith is an associate scientist at Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada, and an adjunct lecturer at Lawrence S. Bloomberg Faculty of Nursing, University of Toronto.

Kelly Metcalfe is a professor and the associate dean of Research and External Relations and Martine Puts is an associate professor and the director of the Masters of Nursing program at Lawrence S. Bloomberg Faculty of Nursing.

出版信息

Am J Crit Care. 2020 Jul 1;29(4):301-310. doi: 10.4037/ajcc2020307.

DOI:10.4037/ajcc2020307

PMID:32607568

Abstract

BACKGROUND

Most intensive care patients require substitute decision makers (SDMs) to make decisions. The SDMs may prefer an active, shared, or passive decision-making role. Role incongruence is when preferred and actual roles differ.

OBJECTIVE

To evaluate the impact of decision-making role preferences and role incongruence on psychological distress symptoms in SDMs.

METHODS

A multicenter, interviewer-administered survey was conducted among SDMs of critically ill adults. The Control Preferences Scale was used to evaluate role preferences. Psychological distress was defined as anxiety, depression, or posttraumatic stress symptoms with predefined cut points on the Hospital Anxiety and Depression Scale (score > 10 on the anxiety or the depression subscale) and Impact of Events Scale (score > 30).

RESULTS

One hundred eighty SDMs were recruited; 64% responded. Most were white (71%) and female (65%); 46% were spouses. Role preferences varied: active, 24%; shared, 44%; and passive, 31%. Almost half (49%) reported incongruence. Symptom prevalence was 50% for posttraumatic stress, 32% for anxiety, and 16% for depression. Most (56%) reported some psychological distress. In multivariable logistic regression, the composite outcome of psychological distress was independently associated with patient death (odds ratio, 2.95; 95% CI, 1.08-8.02; P = .03), female sex of SDM (odds ratio, 2.96; 95% CI, 1.49-5.89; P = .002), and incongruence (odds ratio, 3.26; 95% CI, 1.67-6.36; P < .001).

CONCLUSIONS

Adverse psychological symptoms are prevalent in SDMs of critically ill patients and are related to role incongruence.

摘要

背景

大多数重症监护患者需要替代决策人（SDM）来做出决策。SDM 可能更喜欢积极、共享或被动的决策角色。角色不一致是指偏好的角色和实际的角色不同。

目的

评估决策角色偏好和角色不一致对 SDM 心理困扰症状的影响。

方法

对重症成人患者的 SDM 进行了一项多中心、访谈者管理的调查。使用控制偏好量表来评估角色偏好。心理困扰定义为焦虑、抑郁或创伤后应激症状，采用医院焦虑抑郁量表（焦虑或抑郁亚量表得分>10）和事件影响量表（得分>30）的预设切点。

结果

共招募了 180 名 SDM，64%的人作出了回应。大多数是白人（71%）和女性（65%）；46%是配偶。角色偏好各不相同：积极的占 24%；共享的占 44%；被动的占 31%。近一半（49%）报告存在角色不一致。创伤后应激症状的患病率为 50%，焦虑症状的患病率为 32%，抑郁症状的患病率为 16%。大多数（56%）报告存在某种心理困扰。多变量逻辑回归显示，心理困扰的综合结局与患者死亡独立相关（比值比，2.95；95%置信区间，1.08-8.02；P=0.03）、SDM 的女性性别（比值比，2.96；95%置信区间，1.49-5.89；P=0.002）和角色不一致（比值比，3.26；95%置信区间，1.67-6.36；P<0.001）。