心脏骤停后的医生家庭冲突:一种定性研究
Narrative inquiry in bioethics
|April 25, 2024
概括
心脏骤停患者的家属经常选择继续维持生命,即使神经学预后不佳. 这些决定的关键主题包括信仰,避免"玩上帝",并重视与亲人共度额外的时间.
科学领域:
- 医学伦理 医学伦理
- 神经学 神经学
- 心脏病学 心脏病学
背景情况:
- 昏迷中心脏骤停的幸存者面临着由于神经预后不佳而停止维持生命治疗 (WLST) 的决定.
- 家庭成员充当了代理决策者,尽管存在风险,他们经常面临继续机械通风的选择.
- 医生和家庭之间关于患者最佳利益的分歧可能会导致严重的痛苦.
研究的目的:
- 检查影响家庭决定对心脏骤停幸存者进行持续生命支持的主题,与医疗建议相反.
- 了解指导代孕决策的观点和价值观,在临终关怀中为重症患者提供代孕护理.
主要方法:
- 哥伦比亚大学医学中心 (CUMC) 的24名心脏骤停患者的医疗记录的回顾性审查.
- 分析了患者家属和医疗保健提供者之间关于生命支持决策的记录对话.
- 在家庭提供者讨论中识别和分类反复出现的主题.
主要成果:
- 家庭对持续生命支持的决定受到诸如对奇迹的信仰和与病人共度更多时间的愿望等主题的影响.
- 担心"扮演上帝"以及家庭和提供者之间对患者地位的不同看法是突出的.
- 家庭优先考虑的价值观有时与基于神经学预后的医生建议分歧.
结论:
- 家庭提供者沟通和不同的价值体系对心脏骤停幸存者的终身决策产生重大影响.
- 了解这些主题对于改善共享决策和减少重症监护机构的痛苦至关重要.
- 对弥合这些感知和价值差距的进一步研究可以增强以患者为中心的护理和家庭支持.
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