心理因素对医生临终治疗强度的影响：系统评价与元分析。
Psychological Determinants of Physician Variation in End-of-Life Treatment Intensity: A Systematic Review and Meta-Synthesis.
机构信息
Rutgers University, New Brunswick, NJ, USA.
University of Rochester Medical Center, Rochester, NY, USA.
出版信息
J Gen Intern Med. 2023 May;38(6):1516-1525. doi: 10.1007/s11606-022-08011-4. Epub 2023 Feb 2.
BACKGROUND
Physicians treating similar patients in similar care-delivery contexts vary in the intensity of life-extending care provided to their patients at the end-of-life. Physician psychological propensities are an important potential determinant of this variability, but the pertinent literature has yet to be synthesized.
OBJECTIVE
Conduct a review of qualitative studies to explicate whether and how psychological propensities could result in some physicians providing more intensive treatment than others.
METHODS
Systematic searches were conducted in five major electronic databases-MEDLINE ALL (Ovid), Embase (Elsevier), CINAHL (EBSCO), PsycINFO (Ovid), and Cochrane CENTRAL (Wiley)-to identify eligible studies (earliest available date to August 2021). Eligibility criteria included examination of a physician psychological factor as relating to end-of-life care intensity in advanced life-limiting illness. Findings from individual studies were pooled and synthesized using thematic analysis, which identified common, prevalent themes across findings.
RESULTS
The search identified 5623 references, of which 28 were included in the final synthesis. Seven psychological propensities were identified as influencing physician judgments regarding whether and when to withhold or de-escalate life-extending treatments resulting in higher treatment intensity: (1) professional identity as someone who extends lifespan, (2) mortality aversion, (3) communication avoidance, (4) conflict avoidance, (5) personal values favoring life extension, (6) decisional avoidance, and (7) over-optimism.
CONCLUSIONS
Psychological propensities could influence physician judgments regarding whether and when to de-escalate life-extending treatments. Future work should examine how individual and environmental factors combine to create such propensities, and how addressing these propensities could reduce physician-attributed variation in end-of-life care intensity.
背景
在相似的医疗照护环境下，治疗相似患者的医师在临终时提供的延长生命的照护强度存在差异。医师的心理倾向是造成这种差异的一个重要潜在决定因素，但相关文献尚未被综合。
目的
对定性研究进行综述，以阐明心理倾向是否以及如何导致一些医师提供比其他医师更密集的治疗。
方法
在五个主要的电子数据库（Ovid 的 MEDLINE ALL、Elsevier 的 Embase、EBSCO 的 CINAHL、Ovid 的 PsycINFO 和 Wiley 的 Cochrane CENTRAL）中进行了系统检索，以确定符合条件的研究（最早可追溯到 2021 年 8 月）。纳入标准包括检查医师心理因素与晚期生命有限疾病的临终关怀强度的关系。使用主题分析对来自各个研究的结果进行汇总和综合，主题分析确定了研究结果中常见的、普遍存在的主题。
结果
搜索共确定了 5623 篇参考文献，其中 28 篇被纳入最终的综合分析。确定了 7 种心理倾向，它们影响医师对是否以及何时停止或减少延长生命的治疗的判断，从而导致更高的治疗强度：（1）作为延长寿命的人的专业身份，（2）对死亡的厌恶，（3）避免沟通，（4）避免冲突，（5）个人价值观赞成延长生命，（6）决策回避，和（7）过度乐观。
结论
心理倾向可能影响医师对是否以及何时停止延长生命的治疗的判断。未来的工作应该研究个体和环境因素如何结合产生这种倾向，以及如何解决这些倾向可以减少医师归因于临终关怀强度的差异。
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