重症患者の共同意思決定の効果:体系的なレビューとメタ解析
Yangyang Wang1,2, Jiaqi Li1, Na Yin1
1Department of Public Health and Nursing, Hangzhou Normal University, Zhejiang, China.
Frontiers in medicine
|February 16, 2026
まとめ
共同意思決定 (SDM) は,重症患者の死亡率や整体入院期間 (LOS) に影響しませんでした. しかし,SDMは,死亡した患者の集中治療室 (ICU) のLOSを減らすことと関連していました.
科学分野:
- クリティカルケア・メディシン
- 医療サービス 研究 医療サービス
- 患者中心のケア
背景:
- 共同意思決定 (SDM) は,集中治療においてますます重要であると認識されています.
- 重症患者とその代理人に対する結果へのその影響は,包括的な評価を必要とします.
研究 の 目的:
- 重症患者に対するSDMの効果を体系的にレビューし,メタ分析する.
- SDMが死亡率,集中治療室 (ICU),入院期間 (LOS),および患者および代理母に対する精神保健のアウトカムに及ぼす影響を評価する.
主な方法:
- PRISMAのガイドラインに従った体系的なレビューとメタ分析.
- 主要なデータベース (PubMed,EMBASE,Web of Science,Cochrane) で2025年3月まで発表されたランダム化比較試験 (RCT) を検索しました.
- コクランツールを使用してバイアスのリスクを評価し,固定またはランダム効果モデルでデータを合成しました.
主要な成果:
- 3,678人のICU患者と2,777人の代理人を含む15件のRCTが分析されました.
- SDMと全因死亡率 (RR 1.05,95%CI 0.97-1.15) の間に有意な関連性が見つかりませんでした.
- ICU LOSは,死亡した患者 (SMD -0.15,p=0.02) については減少したが,ICUまたは病院の LOS全体には影響はなかった.
- SDMは代用精神疾患 (うつ,不安,PTSD) の結果や意思決定やコミュニケーションの質を向上させなかった.
結論:
- 共同意思決定は,死亡する重症患者のICU滞在期間を短縮しても,死亡率や整体入院期間に影響を与えない.
- 多様な患者および代理母のニーズを満たすために,文化に合わせたSDM介入に関するさらなる研究が必要である.
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