Lu Qing, Ji Juan, Lu Xiao-Yan, Yin Qiong-Hua, Yang Yi-Qun
Department of Intensive Care Unit, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.
Department of Outpatient, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.
J Multidiscip Healthc. 2025 Jul 31;18:4535-4550. doi: 10.2147/JMDH.S525581. eCollection 2025.
It is necessary to understand the decision-making dynamics between physicians and families so as to help families better participate in shared decision-making.
A qualitative observational research was conducted. Conversations between physicians and families at a tertiary care hospital from July to December 2022 were audio-recorded. The families were those with critically ill patients lacking decision-making capacity in the intensive care unit. Data were analyzed using an inductive content analysis method.
A total of 40 conversations were analyzed. There were 12, 15, and 13 decisions made on the day of hospital admission, when the patient's condition changed, and during the end-of-life situation, respectively. In all decision-making stages, some sharing of information occurred between physicians and families. The degree of sharing differed depending on the decision-making context. In end-of-life situations, decision-making mostly involved families, which might only represent the values and preferences from family members but not patients.
Evidence of shared decision-making between physicians and family members was low. The levels of shared decision-making varied according to the context in which decisions were made. The shared decision-making between physicians and families might only represent the values and preferences from family members but not patients. Family members often faced decision-making difficulties and regrets.
有必要了解医生与家属之间的决策动态，以帮助家属更好地参与共同决策。
进行了一项定性观察研究。对一家三级护理医院2022年7月至12月期间医生与家属之间的对话进行了录音。这些家属是在重症监护病房中患有缺乏决策能力的重症患者的家属。采用归纳性内容分析法对数据进行分析。
共分析了40次对话。分别在入院当天、患者病情变化时以及临终阶段做出了12次、15次和13次决策。在所有决策阶段，医生与家属之间都有一定程度的信息共享。共享程度因决策背景而异。在临终阶段，决策大多由家属做出，这可能仅代表家庭成员而非患者的价值观和偏好。
医生与家属之间共同决策的证据较少。共同决策的水平因决策背景而异。医生与家属之间的共同决策可能仅代表家庭成员而非患者的价值观和偏好。家属经常面临决策困难和遗憾。
