ICU临终病人家属决策体验质性研究的系统评价

Systematic evaluation of qualitative researches on decision-making experience of family members of end-of-life patients in ICU

[目的]系统评价重症监护室(ICU)临终病人家属决策的情感体验和需求,为医院开展ICU临终决策支持工作提供依据。[方法]计算机检索外文数据库PubMed、EMbase、the Cochrane Library、Web of Science、CINAHL、PsyCINFO以及中文数据库中国知网(CNKI)、万方数据资源系统、中国生物医学文献数据库(CBM)、维普数据库(VIP),收集关于ICU临终病人家属决策体验的质性研究。检索时限2009年1月1日—2019年1月1日。采用澳大利亚JBI循证卫生保健中心质性研究质量评价标准对文献进行评价,并采用汇集性整合方法对结果进行整合。[结果]共纳入13项研究,提炼出45个完整的研究结果,归类成6个新类别,综合成2个整合结果。整合结果1:家属因复杂的心理活动、沉重的精神负担、诸多的不确定性,故而陷入决策困境。整合结果2:家属希望发挥角色的积极作用,渴求外界支持。[结论]临床工作人员应深刻地认识到ICU临终病人家属存在的决策困境和需求,给予决策支持,提高决策质量,更好地展现医院的人文关怀和医疗服务质量。

Objectives:To systematically review the decision-making need and experience of family members of dying patients in ICU,and to provide evidence-based guidance for developing support word related to end-of-life decision-making in hospital.Methods:Qualitative researches about end-of-life decision-making experience of family members of dying patients in ICU,were retrieved from PubMed,EMbase,the Cochrane Library,Web of Science,CINAHL,PsyCINFO and CNKI,WanFang Database,CBM,VIP.The retrieval time was from January 1,2009 to January 1,2019.The JBI critical appraisal checklist for qualitative researches in Australia,was used to evaluate the quality of included studies.The results were integrated by adopting the method of aggregation integration.Results:A total of 13 studies were included,and 45 complete findings were refined according to their similarities.Then,they were classified into 6 new categories,which were synthesized two integration synthesized findings.Integration result 1:family members are trapped in decision-making dilemma because of their complicated psychological activities,heavy spiritual burden and many uncertainties.Integration result 2:family members desire to play a positive role in surrogates,and eager for outside support.Conclusions:Clinical staff should deeply recognize the existing difficulties and needs of decision-making of the family members of the dying patients in ICU,provide decision-making support,improve the quality of decision-making,and better show the humanistic care and quality of medical service in hospital.