了解临床实践中提供者级别的变化:在败血性休克中对皮质类固醇使用的纵向调查
Kanupriya Soni1, Leigh A Bukowski2, Billie S Davis2
1Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
CHEST critical care
|June 27, 2025
概括
强化疗法临床医生的风险耐受性影响了他们使用皮质类固醇治疗败血症休克的决定. 了解心理因素可以帮助规范ICU实践,改善证据采用.
科学领域:
- 临界护理医学 临界护理医学
- 医学心理学 医学心理学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 在ICU中,实践的变化很常见,特别是在有中度证据的治疗中.
- 影响临床医生的决策的心理因素尚不清楚.
- 标准化实践和加速采用证据是关键目标.
研究的目的:
- 调查心理特征与ICU中的临床实践模式之间的关联.
- 为了确定个体心理因素是否预测密集医生愿意使用皮质类固醇治疗败血症休克.
主要方法:
- 从2018年到2021年,对201名重症监护医生进行了纵向问卷调查.
- 评估了使用临床图片用皮质类固醇治疗败血症休克的意愿.
- 测量心理特征,包括风险耐受性和对证据强度和作用机制的看法.
- 使用多变量回归来分析心理因素和治疗决定之间的关系.
主要成果:
- 到2021年,使用皮质固醇治疗的意愿从15.3%增加到24.4%.
- 更高的风险耐受性 (OR, 1.34) 和感知证据强度 (OR, 1.45) 与增加治疗意愿有显著联系.
- 对作用机制和其他心理因素的感知理解与治疗决策没有相关性.
结论:
- 个体的风险承受能力是与密集治疗师愿意为败血症休克处方皮质类固醇相关的重要因素.
- 心理特征,特别是风险耐受性,可能是标准化实践干预的目标.
- 进一步研究临床决策的心理决定因素是有必要的,以改善基于证据的ICU护理.
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