Research Unit, Department of Anaesthesia, Surgery and Intensive Care, Herlev Hospital, Copenhagen, Denmark.
Department of Anaesthesia, Zealand University Hospital, Koege, Denmark.
Br J Anaesth. 2023 Dec;131(6):1014-1021. doi: 10.1016/j.bja.2023.08.002. Epub 2023 Aug 31.
Family presence during resuscitation is a growing topic in the field of prehospital emergency medicine. Emergency medicine service (EMS) providers interact with the relatives of acutely critically ill patients daily. Previous studies have found varying preferences towards family presence during resuscitation. Some EMS providers experience family presence affects patient treatment. The study aimed to gain insight into how EMS providers experience relatives of critically ill patients influence patient treatment.
We used semi-structured individual interviews of specially trained paramedics and anaesthetists specialised in prehospital emergency medicine. A total of 11 interviews were conducted at a University Hospital in Copenhagen. Inductive qualitative contents analysis was used to analyse the data.
Relatives were defined as family, spouses, children, partners, close friends or colleagues, and, for some participants, more peripheral relationships such as schoolmates or acquaintances. We identified four themes, describing how EMS providers experience relatives' influence on patient treatment: 'supporting optimal patient treatment', 'futile resuscitation', 'negative impact on patient treatment', and 'the paediatric patient'.
Our study illustrates how EMS providers experience that treatment is influenced by relatives of acutely critically ill patients in the prehospital emergency medicine setting. Relatives can help or challenge treatment, and also influence EMS providers' clinical decision-making. Our findings can guide those working in prehospital emergency medicine towards utilising relatives of critically ill patients and increasing our understanding of how relatives can influence EMS providers' treatment and their clinical decision-making. Future studies should seek to quantify relatives' effect on treatment and investigate the clinical and ethical aspects of futile resuscitation.
在院前急救医学领域，患者家属在复苏过程中的存在是一个日益受到关注的话题。急救医疗服务（EMS）提供者每天都会与急性危重症患者的家属进行互动。先前的研究发现，对于在复苏过程中家属的存在，人们的偏好存在差异。一些 EMS 提供者认为家属的存在会影响患者的治疗。本研究旨在深入了解 EMS 提供者如何体验危重症患者家属对患者治疗的影响。
我们对专门接受过院前急救医学培训的急救人员和麻醉师进行了半结构化的个体访谈。总共在哥本哈根的一家大学医院进行了 11 次访谈。采用归纳性定性内容分析来分析数据。
家属被定义为亲属、配偶、子女、伴侣、亲密朋友或同事，对于一些参与者来说，还包括更外围的关系，如同学或熟人。我们确定了四个主题，描述了 EMS 提供者如何体验家属对患者治疗的影响：“支持最佳患者治疗”、“无效复苏”、“对患者治疗产生负面影响”和“儿科患者”。
我们的研究说明了 EMS 提供者如何体验到患者在院前急救医学环境中，其治疗受到急性危重症患者家属的影响。亲属可以帮助或挑战治疗，也会影响 EMS 提供者的临床决策。我们的研究结果可以为从事院前急救医学的人员提供指导，帮助他们更好地利用危重症患者的家属，并增加我们对亲属如何影响 EMS 提供者的治疗和临床决策的理解。未来的研究应寻求量化亲属对治疗的影响，并调查无效复苏的临床和伦理方面。
