ICU生命末期病人临终决策制定的影响因素

Influencing Factors in Making End-of-life Decisions for ICU Terminal Patients

对西南地区5家三甲医院重症监护病房(intensive care unit,ICU)的15名医护人员进行面对面的深度访谈,对影响医护人员为病人做出临终决策的因素进行研究。影响ICU医护人员做出临终决策的原因包括:紧张的医患关系、欠缺对安宁疗护的认知、医疗卫生政策限制、经济因素。其中,影响ICU医护人员做出临终决策最主要的因素是病人的经济情况和当前的医疗法规,而不是病人的病情及病人自主权。应从医学、经济、政策法律和教育四方面建立有效的应对机制,使ICU临终决策实践有法可依、有章可循,有效保护医护人员、病人及家属的利益。

Face-to-face and in-depth interviews were conducted with 15 medical staff from the ICU of 5 tertiary grade A hospitals in southwest China to study the factors affecting the end-of-life decisions made by medical staff for patients.These factors include:strained doctor-patient relationship;inadequate awareness of hospice care;health policy constraints;economic factors.The most important factor influencing clinical decision-making of ICU medical staff is not the patient's condition and patient autonomy,but the economic and current medical regulations.The effective coping mechanism should be established from the aspects of medicine,economy,law and education.The clinical decision-making practice of ICU needs rules to follow,therefore to effectively protect the interests of medical staff,patients and their families.