ICU患者家属参与决策的现况研究

Involvement of family members of ICU patients in decision making process:a cross-sectional study

目的了解ICU患者家属在决策中期望参与程度和实际参与情况,并分析决策参与期望的影响因素。方法采用一般资料调查表和决策参与期望量表,对杭州市某三甲医院的100名ICU患者家属进行调查。结果在决策参与期望的调查中,46.0%的家属选择合作型,35.0%的家属选择被动型,19.0%的家属选择主动型。家属参与决策的期望和实际情况存在差异,期望参与决策的程度高于实际参与水平(χ^2=14.894,P<0.05),两者一致性检验的Kappa值为0.272,符合率为54.0%。多元有序Logistic回归分析结果显示,家属的年龄、文化程度和性格是决策参与期望的主要影响因素。结论近半数家属在决策中扮演了与期望不一致的参与角色,建议医护人员在决策前评估家属的决策参与期望水平,给予个性化的沟通方式,实施与之匹配的决策模式。

Objective To investigate the expectation and actuality of decision preferences on family members of ICU patients,and to explore influencing factors of decision control preferences.Methods A total of 100 ICU patients'family members from a tertiary hospital in Hangzhou were investigated with general information questionnaire and Control Preference Scale.Results The decision control preference investigation result showed that 46.0%of the relatives chose the collaborative type,35.0%of relatives chose the passive type,and 19.0%of relatives chose the active type.There was difference between expectation and actual decision making.Statistical analysis showed that the degree of expectation was higher than that of actual decision making(χ^2=14.894,P<0.05),the consistency between them was poor(Kappa=0.272),and the coincidence rate was 54.0%.Multivariate and ordered logistic regression analysis showed that main influencing factors of decision control preferences were relatives'age,education level and characters.Conclusion About 50.0%of family members experienced discordance between their preferences and actual roles.This highlights the need for medical workers to assess individual decision preferences before decision making in order to give individualized communication styles and implement the matched decision model.