NURSE-LED INTERVENTION TO IMPROVE SURROGATE DECISION MAKING FOR PATIENTS WITH ADVANCED CRITICAL ILLNESS

被引:73
作者
White, Douglas B. [1 ]
Cua, Sarah Martin [2 ]
Walk, Roberta [3 ]
Pollice, Laura [4 ]
Weissfeld, Lisa
Hong, Seoyeon
Landefeld, C. Seth [5 ]
Arnold, Robert M. [6 ]
机构
[1] Univ Pittsburgh, Sch Med, Dept Crit Care Med, Program Ethics & Decis Making, Pittsburgh, PA 15261 USA
[2] Univ Pittsburgh, Med Ctr, Pittsburgh, PA 15260 USA
[3] Univ Pittsburgh, Sch Dent, Pittsburgh, PA 15260 USA
[4] Univ Pittsburgh, Inst Canc, Clin Trials Program, Pittsburgh, PA 15260 USA
[5] Univ Alabama, Birmingham Sch Med, Tuscaloosa, AL 35487 USA
[6] Univ Pittsburgh, Sect Palliat Care & Med Ethics, Pittsburgh, PA 15260 USA
关键词
END-OF-LIFE; INTENSIVE-CARE-UNIT; FAMILY SATISFACTION; SUSTAINING TREATMENT; PALLIATIVE CARE; CENTERED CARE; ILL PATIENTS; COMMUNICATION; IMPACT; CONFERENCES;
D O I
10.4037/ajcc2012223
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background Problems persist with surrogate decision making in intensive care units, leading to distress for surrogates and treatment that may not reflect patients' values. Objectives To assess the feasibility, acceptability, and perceived effectiveness of a multifaceted, nurse-led intervention to improve surrogate decision making in intensive care units. Study Design A single-center, single-arm, interventional study in which 35 surrogates and 15 physicians received the Four Supports Intervention, which involved incorporating a family support specialist into the intensive care team. That specialist maintained a longitudinal relationship with surrogates and provided emotional support, communication support, decision support, and anticipatory grief support. A mixed-methods approach was used to evaluate the intervention. Results The intervention was implemented successfully in all 15 patients, with a high level of completion of each component of the intervention. The family support specialist devoted a mean of 48 (SD 36) minutes per day to each clinician-patient-family triad. All participants reported that they would recommend the intervention to others. At least 90% of physicians and surrogates reported that the intervention (1) improved the quality and timeliness of communication, (2) facilitated discussion of the patient's values and treatment preferences, and (3) improved the patient-centeredness of care. Conclusions The Four Supports Intervention is feasible, acceptable, and was perceived by physicians and surrogates to improve the quality of decision making and the patient-centeredness of care. A randomized trial is warranted to determine whether the intervention improves patient, family, and health system outcomes. (American Journal of Critical Care. 2012;21:396-409)
引用
收藏
页码:396 / 409
页数:14
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