ICU患者家属决策冲突现状及影响因素研究

Research on the status quo and influencing factors of decision conflict among family members of ICU patients

目的 描述ICU患者家属决策冲突的发生情况,并探讨其影响因素。方法 采用便利抽样法,于2022年1月-7月在浙江省某三级甲等医院的成人ICU病区,应用决策冲突量表对252名ICU患者家属进行调查,分析其决策冲突的发生情况,采用卡方检验、独立样本t检验、秩和检验和逻辑回归进行影响因素分析。结果 ICU患者家属的决策冲突发生率为52.0%。单因素分析显示,决策冲突组和无决策冲突组的患者入院24 h内急性生理与慢性健康评分Ⅱ(Acute Physiology and Chronic Health EvaluationⅡ,APACHEⅡ)评分,家属的年龄、文化程度、婚姻状况、家庭人均月收入、医疗负担、与患者的关系、决策准备、决策疲劳和决策风格差异具有统计学意义(P<0.05);多因素分析显示,患者入院24 h内APACHEⅡ评分(OR=1.130,P<0.001)、家属的决策疲劳(OR=1.230,P=0.001)及回避型决策风格(OR=1.183,P=0.027)是决策冲突的危险因素,而家属的决策准备(OR=0.967,P=0.047)和直觉-冲动型决策风格(OR=0.824,P=0.026)是决策冲突的保护因素。结论 ICU患者家属决策冲突发生率高,患者入院24 h内高APACHEⅡ评分、家属低决策准备、高决策疲劳、高回避型决策风格和低直觉-冲动型决策风格可能为ICU患者家属决策冲突发生的影响因素。医疗保健者可通过提高家属对决策的认知准备、重视家属的决策状态和情感需求、探究回避行为产生的原因及明晰家属的决策原则等方式制订符合我国ICU情境下的决策冲突干预方案。

Objective To describe the current situation of decision conflict among family members of ICU patients and explore the risk factors.Methods Using convenience sampling method,we employed Decision Conflict Scale to investigate the 252 family members of ICU patients in the adult ICU ward of a tertiary class A hospital in Zhejiang Province from January 2022 to July 2022,and analyzed the occurrence of decision conflict.Influencing factors were analyzed by Chi-square test,independent sample t-test,rank sum test and logistic regression.Results The incidence of decision conflict in the sample population was 52.0%.Univariate analysis showed that,there were significant differences in patients'APACHE I score within 24 hours of admission,family members'age,education level,marital status,family per capita monthly income,medical burden,relationship with patients,decision preparation,decision fatigue and decision style between the decision conflict group and the non-decision conflict group(P<0.05).Multivariate analysis showed that patients'APACHEI score within 24 hours of admission(OR=1.130,P<0.001),family members'decision fatigue(OR=1.230,P=0.001)and avoidant decision style(OR=1.183,P=0.027)were risk factors for decision conflict,while their decision preparation(OR=0.967,P=0.047)and intuition-spontaneous decision style(OR=0.824,P=0.026)were protective factors.Conclusion The incidence of decision conflict among family members of ICU patients was high.High patients'APACHE II score within 24 hours of admission,low decision preparation,high decision fatigue,high avoidant decision style and low intuition-spontaneous decision style might be the influencing factors of family members'decision conflict.Through improving family members'cognitive preparation,paying attention to their decision-making state and emotional needs,exploring the causes of avoidance behavior and clarifying their decision principles,health care providers can formulate decision conflict intervention programs that are suitable for the ICU context in China.