医疗机构中医疗保健提供者对危重症患者预先医疗照护计划的认知：一项横断面研究。
Healthcare providers' perception of advance care planning for patients with critical illnesses in acute-care hospitals: a cross-sectional study.
机构信息
Department of Critical Care Nursing, Graduate School of Nursing Science, St. Luke's International University, 10-1, Akashi-cho, Tokyo, Japan.
Department of Nursing Informatics, Graduate School of Nursing Science, St. Luke's International University, 10-1, Akashi-cho, Tokyo, Japan.
出版信息
BMC Palliat Care. 2022 Jan 7;21(1):7. doi: 10.1186/s12904-021-00900-5.
BACKGROUND
In acute-care hospitals, patients treated in an ICU for surgical reasons or sudden deterioration are treated in an outpatient ward, ICU, and other multiple departments. It is unclear how healthcare providers are initiating advance care planning (ACP) for such patients and assisting them with it. The purpose of this study is to clarify healthcare providers' perceptions of the ACP support provided to patients receiving critical care in acute-care hospitals.
METHODS
A cross-sectional study was conducted using questionnaires. In this study, 400 acute-care hospitals with ICUs in Japan were randomly selected, and 1490 subjects, including intensivists, surgeons, ICU nurses, surgical floor nurses, and surgical outpatient nurses, participated. Survey items examined whether ICU patients received ACP support, the participants' degree of confidence in providing ACP support, the patients' treatment preferences, and the decision-making process, and whether any discussion was conducted on change of values.
RESULTS
Responses were obtained from 598 participants from 157 hospitals, 41.4% of which reportedly supported ACP provision to ICU patients. The subjects with the highest level of ACP understanding were surgeons (45.8%), and differences in understanding were observed across specialties (P < 0.001). Among the respondents, physicians and nurses expressed high levels of confidence in providing ACP support to patients requiring critical care. However, 15.2% of all the subjects mentioned that they would not attempt to resuscitate the patients. In addition, 25.7% of the participants handed over patients' values to other departments or hospitals, whereas 25.3% handed over the decision-making process.
CONCLUSIONS
Among the participating hospitals, 40% provided ACP support to patients receiving critical care. The low number is possibly because support providers lack understanding of the content of patients' ACP or about how to support and use ACP. Second, it is sometimes too late to start providing ACP support after ICU admission. Third, healthcare providers differ in their perception of ACP, widely considered an ambiguous concept. Finally, in acute-care hospitals with different healthcare settings, it is necessary to confirm and integrate the changes in feelings and thoughts of patients.
背景
在急症医院，因外科原因或病情突然恶化而在 ICU 接受治疗的患者会在门诊病房、ICU 和其他多个科室接受治疗。目前尚不清楚医疗保健提供者如何为这些患者启动并协助进行预先医疗指示（ACP）。本研究旨在阐明医疗保健提供者对在急症医院接受重症监护的患者提供的 ACP 支持的看法。
方法
采用问卷调查进行了一项横断面研究。在这项研究中，日本随机选择了 400 家设有 ICU 的急症医院，共有包括重症监护医师、外科医师、ICU 护士、外科病房护士和外科门诊护士在内的 1490 名参与者参与。调查项目包括 ICU 患者是否接受 ACP 支持、参与者提供 ACP 支持的信心程度、患者的治疗偏好和决策过程，以及是否就价值观的变化进行了讨论。
结果
从 157 家医院的 598 名参与者处获得了回复，其中 41.4%的医院报告称支持为 ICU 患者提供 ACP。对 ACP 理解程度最高的是外科医师（45.8%），不同专业之间存在理解差异（P < 0.001）。在回答者中，医生和护士对为需要重症监护的患者提供 ACP 支持表示出高度的信心。然而，所有参与者中有 15.2%表示不会尝试对患者进行心肺复苏。此外，25.7%的参与者将患者的价值观转交给其他科室或医院，而 25.3%的参与者转交了决策过程。
结论
在参与研究的医院中，有 40%的医院为接受重症监护的患者提供 ACP 支持。这一低比例可能是因为支持提供者对患者 ACP 的内容或如何支持和使用 ACP 缺乏了解。其次，在 ICU 入院后开始提供 ACP 支持有时为时已晚。第三，医疗保健提供者对 ACP 的看法存在差异，认为这是一个模糊的概念。最后，在具有不同医疗保健环境的急症医院中，有必要确认和整合患者感受和想法的变化。
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