Talking About Suffering in the Intensive Care Unit.

Q1 Arts and Humanities
Brent M Kious, Judith B Vick, Peter A Ubel, Olivia Sutton, Jennifer Blumenthal-Barby, Christopher E Cox, Deepshikha Ashana
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引用次数: 0

Abstract

Background: Some have hypothesized that talk about suffering can be used by clinicians to motivate difficult decisions, especially to argue for reducing treatment at the end of life. We examined how talk about suffering is related to decision-making for critically ill patients, by evaluating transcripts of conversations between clinicians and patients' families.

Methods: We conducted a secondary qualitative content analysis of audio-recorded family meetings from a multicenter trial conducted in the adult intensive care units of five hospitals from 2012-2017 to look at how the term "suffering" and its variants were used. A coding guide was developed by consensus-oriented discussion by four members of the research team. Two coders independently evaluated each transcript. We followed an inductive approach to data analysis in reviewing transcripts; findings were iteratively discussed among study authors until consensus on key themes was reached.

Results: Of 146 available transcripts, 34 (23%) contained the word "suffer" or "suffering" at least once, with 58 distinct uses. Clinicians contributed 62% of first uses. Among uses describing the suffering of persons, 57% (n = 24) were related to a decision, but only 42% (n = 10) of decision-relevant uses accompanied a proposal to limit treatment, and only half of treatment-limiting uses (n = 5) were initiated by clinicians. The target terms had a variety of implicit meanings, including poor prognosis, reduced functioning, pain, discomfort, low quality of life, and emotional distress. Suffering was frequently attributed to persons who were unconscious.

Conclusions: Our results did not support the claim that the term "suffering" and its variants are used primarily by clinicians to justify limiting treatment, and the terms were not commonly used in our sample when decisions were requested. Still, when these terms were used, they were often used in a decision-relevant fashion.

在重症监护室谈论痛苦。
背景:有人假设,临床医生可以通过谈论痛苦来促使患者做出艰难的决定,尤其是在生命末期主张减少治疗。我们通过评估临床医生与患者家属之间的谈话记录,研究了关于痛苦的谈话与重症患者决策之间的关系:我们对 2012-2017 年期间在五家医院的成人重症监护病房进行的一项多中心试验中的家庭会议录音进行了二次定性内容分析,以了解 "痛苦 "一词及其变体是如何使用的。研究团队的四名成员通过以共识为导向的讨论制定了编码指南。两名编码员独立评估每份记录誊本。我们在审阅记录誊本时采用了归纳式数据分析方法;研究结果在研究作者之间反复讨论,直到就关键主题达成共识:在现有的 146 份记录誊本中,有 34 份(23%)至少包含一次 "遭受 "或 "痛苦 "一词,其中有 58 次不同的用法。临床医生占首次使用的 62%。在描述人的痛苦的用法中,57%(n = 24)与决策有关,但只有 42%(n = 10)的决策相关用法伴随着限制治疗的建议,只有一半的限制治疗用法(n = 5)是由临床医生提出的。目标术语具有多种隐含含义,包括预后不良、功能减退、疼痛、不适、生活质量低下和情绪困扰。痛苦经常被归咎于无意识的人:我们的研究结果并不支持 "痛苦 "一词及其变体主要被临床医生用来证明限制治疗是合理的这一说法,而且在我们的样本中,当被要求做出决定时,这些术语并不常用。不过,在使用这些术语时,它们往往是以与决定相关的方式使用的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
AJOB Empirical Bioethics
AJOB Empirical Bioethics Arts and Humanities-Philosophy
CiteScore
3.90
自引率
0.00%
发文量
21
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