限制生命维持治疗非常老的ICU患者:文化挑战和多样化的实践
Michael Beil1, Peter Vernon van Heerden2, Gavin M Joynt3
1Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Annals of intensive care
|October 26, 2023
概括
针对老年患者的重症监护室 (ICU) 决策的预后不确定性在全球范围内有所不同. 共享决策原则是常见的,但文化差异影响维持生命治疗 (LST) 选择.
科学领域:
- 关键护理医学 关键护理医学
- 老年医学 老年医学
- 医学伦理 医学伦理
背景情况:
- 在重症监护室 (ICU) 的老年患者的预后包括预测存活率,功能能力和生活质量.
- 预后的重大不确定性导致关于维持生命治疗 (LST) 的各种意见和决定.
- 对于生命科学决策的伦理和法律框架在各国之间存在差异,影响管理策略.
研究的目的:
- 为了探索对非常老的ICU患者LST的各种意见.
- 在不同的医疗保健系统中比较国家建议和专家意见.
- 确定在LST决策中管理预后不确定性的策略.
主要方法:
- 使用了一个87岁多病症患者的图片场景.
- 调查了专门从事老年护理的重症监护医生的专家意见.
- 分析了来自十个不同文化和医疗保健系统的国家/地区的国家建议.
主要成果:
- 在不同国家管理非常老的ICU患者时,存在共同的原则.
- 一些国家指南承认文化差异影响LST决策.
- 虽然建议与家庭达成共识,但共同决策并非普遍实行或要求.
结论:
- 在非常老的ICU患者的LST决策中发现了相似之处和差异.
- 建议制定策略,以应对预后不确定性和文化差异.
- 在这个专业领域,需要加强合作研究和培训.
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