School of Nursing, Columbia University, 560 West 168th Street, New York, NY 10032, United States of America.
Department of Anesthesiology, Columbia University Irving Medical Center, 630 West 168th Street, New York, NY 10032, United States of America.
J Crit Care. 2022 Oct;71:154054. doi: 10.1016/j.jcrc.2022.154054. Epub 2022 May 7.
To understand clinicians' views regarding use of clinical criteria, or triggers, for specialist palliative care consultation in the ICU.
Secondary analysis of a qualitative study that explored factors associated with adoption of specialist palliative care in the ICU. Semi-structured interviews with 36 ICU and palliative care clinicians included questions related to triggers for specialist palliative care. We performed a thematic analysis to identify participants' views on use of triggers, including appropriateness of cases for specialists and issues surrounding trigger implementation.
We identified five major themes: 1) Appropriate triggers for specialist palliative care, 2) Issues leading to clinician ambivalence for triggers, 3) Prospective buy-in of stakeholders, 4) Workflow considerations in deploying a trigger system, and 5) Role of ICU clinicians in approving specialist palliative care consults. Appropriate triggers included end-of-life care, chronic critical illness, frequent ICU admissions, and patient/family support. Most clinicians had concerns about "trigger overload" and ICU clinicians wanted to be broadly involved in implementation efforts.
ICU and palliative care clinicians identified important issues to consider when implementing triggers for specialist palliative care consultation. Future research is needed to longitudinally examine the most appropriate triggers and best practices for trigger implementation.
了解临床医生对在 ICU 使用临床标准（或触发因素）来进行专科姑息治疗咨询的看法。
对一项探讨 ICU 中采用专科姑息治疗相关因素的定性研究进行二次分析。对 36 名 ICU 和姑息治疗临床医生进行半结构式访谈，其中包括有关专科姑息治疗触发因素的问题。我们进行了主题分析，以确定参与者对使用触发因素的看法，包括专家介入的病例适宜性以及触发因素实施方面的问题。
我们确定了五个主要主题：1）专科姑息治疗的适当触发因素，2）导致临床医生对触发因素产生矛盾情绪的问题，3）利益相关者的前瞻性认同，4）部署触发系统时的工作流程考虑因素，5）ICU 临床医生在批准专科姑息治疗咨询中的作用。适当的触发因素包括临终关怀、慢性危重病、频繁的 ICU 入院和患者/家庭支持。大多数临床医生对“触发因素过载”表示担忧，而 ICU 临床医生希望广泛参与实施工作。
ICU 和姑息治疗临床医生确定了在实施专科姑息治疗咨询触发因素时需要考虑的重要问题。需要进行未来的研究，以纵向探讨最合适的触发因素和触发因素实施的最佳实践。
