ICU急性肾损伤患者连续性肾脏替代治疗上机时家属决策困境的现象学研究

Family Decision-making Dilemma of Continuous Renal Replacement Therapy for Patients with Acute Kidney Injury in ICU:A Phenomenological Study

目的 探索ICU急性肾损伤患者连续性肾脏替代治疗上机时家属决策过程中面临的困境,为促进医患共同决策提供参考。方法 运用现象学研究方法,选取2022年6-8月在太原市某三级甲等医院ICU内行连续性肾脏替代治疗的患者家属15例进行半结构式访谈,采用Colaizzi七步分析法进行资料分析。结果 患者家属的决策困境包括3个主题:决策困境前因(决策内容复杂、信息来源广泛但利用程度低、决策时间紧急)、决策困境内容(权衡治疗利弊、家庭意见分歧、经济现实与舆论压力的冲突)、决策困境体验(情绪调节失控、认知处理能力下降)。结论 连续性肾脏替代治疗患者家属临床决策存在困境,受多重因素影响,医护人员应关注患者家属连续性肾脏替代治疗上机的决策困境,及时识别其决策状态,采取针对性措施改善其决策困境。

Objective To explore the family decision-making dilemmas of continuous renal replacement therapy(CRRT) for patients with acute kidney injury in ICU,so as to provide references for promoting shared decision-making between doctors and patients.Methods A phenomenological study was conducted and 15 family members of patients who received CRRT in the ICU of a tertiary hospital in Taiyuan City were selected for semi-structured interviews from June to August,2022.The Colaizzi 7-step analysis method was used to analyze the data.Results Three themes on the family decision-making dilemmas were extracted,including antecedents of decision conflicts(complex contents,abundant information with low utility,urgent time),contents of decision conflicts(weighing the pros and cons of treatment,family members holding different opinions,conflicts between economic reality and public pressure),experience of decision conflicts(uncontrolled emotional regulation,decreased cognitive processing ability).Conclusions There are decision-making dilemmas among family members of CRRT patients,which may be affected by multiple factors.Medical staff should pay attention to the family decision-making dilemmas of CRRT for the patients,identify their states of decision-making,and take targeted measures to resolve decision conflicts.