小児の心室補助装置の同情的な無効化に関する臨床医の見解
Kimberly A Pyke-Grimm1,2, Michelle Brown3, Alaa Youssef4
1From the Department of Nursing Research and Evidence-Based Practice, Center for Professional Excellence and Inquiry, Stanford Medicine Children's Health, Palo Alto, California.
まとめ
小児の臨床医は,心室補助器具 (VAD) を無効にすることを決定する際,道徳的な苦悩に直面します. 臨床医の見解を理解することは,子供におけるVADの無効化のためのガイドラインの開発に不可欠です.
科学分野:
- 小児心臓科
- 緩和ケア
- 医学 の 倫理
背景:
- 小児科の患者では,心室補助器具 (VAD) の使用が増加しています.
- VADサポートの望ましい性について,家族と臨床医の見解に相違があります.
- 副作用は患者の生活の質とVADの迅速な再評価に影響を与える可能性があります.
研究 の 目的:
- VADの同情的な無効化 (CD) プロセスに関する小児心不全の臨床医の視点を探求する.
- 小児患者のCD-VADの意思決定に関連する課題とテーマを特定する.
- VADの無効化のための小児専用のガイドラインの開発を参考にする.
主な方法:
- 半構造面接を用いた定性研究
- 21人の小児心不全の臨床医が参加しました
- インタビューはCD-VADに関するプロセスと経験に焦点を当てました.
主要な成果:
- 主なテーマは"CD-VADへの決断"でした.
- 5つのカテゴリーが生まれます コミュニケーションの戦略 人間関係と信頼 時間の大切さ 感情的な負担 介護の方向転換です
- 臨床医は患者の苦しみと 意思決定の不一致による 道徳的・感情的苦痛を報告しました
結論:
- CD-VADの決定におけるコンセンサスは,家族を含むチームディスカッションを通じて達成されます.
- 臨床医の課題を理解することは,統合小児緩和ケア (PPC) ガイドラインの開発に不可欠です.
- 小児のVAD患者でCD-VADが正当化される場合,適切な反応のためのガイドラインが必要です.
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