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探索重症监护病房临终关怀的质量:一项针对穆斯林患者家属的定性多案例研究方法

Exploring the quality of end-of-life care in the intensive care unit: a qualitative multiple case study approach with family members of Muslim patients.

作者信息

Nayfeh Ayah, Conn Lesley Gotlib, Dale Craig, Fowler Robert

机构信息

Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.

出版信息

BMJ Open. 2025 Jan 20;15(1):e087871. doi: 10.1136/bmjopen-2024-087871.

Abstract

OBJECTIVE

Muslim patients are an underrepresented community in end-of-life care research, with little evidence around factors that influence the quality and experience of care. The aim of this study was to explore the quality of end-of-life care in the intensive care unit (ICU) from the perspective of next-of-kin family members of Muslim patients.

DESIGN

A qualitative multiple case study design using semistructured interviews with family members of Muslim patients. Healthcare providers' notes from the patient medical record were also used to contextualise the patient care experience and medical journey. Data were analysed using deductive content analysis.

SETTING

A large academic tertiary care hospital in Toronto, Canada.

PARTICIPANTS

Next-of-kin family members of Muslim patients (≥18 years) who were admitted to the ICU and died in hospital between October 2019 and December 2021.

RESULTS

Family members of five Muslim patients of South Asian descent were recruited for this study. Four central themes were identified: (1) trust and confidence in the healthcare team overseen by medical experts; (2) quality communication with medical experts; (3) achieving patient goals of care; and (4) dignity of care through cultural respect and emotional support. Culture, religion and religiosity did not appear to have a major influence on the medical decision-making process. Communication, emotional and psychological well-being for patients, and cultural respect were identified as possible areas for quality improvement.

CONCLUSIONS

Our findings identified central themes in the quality of end-of-life care for families of seriously ill Muslim patients. These insights can inform clinical processes and interventions to improve the quality of care and reduce psychological and emotional burden at the end of life.

摘要

目的

在临终关怀研究中,穆斯林患者群体的代表性不足,关于影响护理质量和体验的因素的证据很少。本研究的目的是从穆斯林患者近亲家属的角度探讨重症监护病房(ICU)的临终关怀质量。

设计

采用定性多案例研究设计,对穆斯林患者的家属进行半结构式访谈。还使用了患者病历中的医疗服务提供者记录,以了解患者的护理体验和医疗过程。采用演绎性内容分析法对数据进行分析。

地点

加拿大多伦多的一家大型学术三级护理医院。

参与者

2019年10月至2021年12月期间入住ICU并在医院死亡的穆斯林患者(≥18岁)的近亲家属。

结果

招募了五名南亚裔穆斯林患者的家属参与本研究。确定了四个核心主题:(1)对由医学专家监督的医疗团队的信任和信心;(2)与医学专家的高质量沟通;(3)实现患者的护理目标;(4)通过文化尊重和情感支持实现护理尊严。文化、宗教和宗教信仰似乎对医疗决策过程没有重大影响。沟通、患者的情绪和心理健康以及文化尊重被确定为可能需要改进质量的领域。

结论

我们的研究结果确定了重症穆斯林患者家庭临终关怀质量的核心主题。这些见解可为临床流程和干预措施提供参考,以提高护理质量,减轻临终时的心理和情感负担。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2d92/11749587/8275a24f8762/bmjopen-15-1-g001.jpg

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