中国成人急诊重病对话核对表的验证:单中心试点研究。

IF 2.3 3区 医学 Q1 EMERGENCY MEDICINE
Hongxia Ge, Shu Li, Qingbian Ma
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引用次数: 0

摘要

背景:急诊和危重症护理的进步改善了治疗效果,但沟通和决策方面的差距依然存在,尤其是在急诊科(ED):这是一项单中心前瞻性干预研究,旨在提高维持生命治疗(LST)的SIC质量。研究在观察基线和干预阶段连续招募患者,直至结束。符合条件的参与者是在一家三级教学医院急诊重症监护室(EICU)住院的 18 岁以上成年人,具有完全决定能力或有法定代理人。孕妇、入院时已死亡的患者、拒绝参与的患者以及分析数据不完整的患者除外。首先,组织了两轮德尔菲程序,以确定主要要素,并通过核对表生成标准程序。随后,使用决策冲突量表(DCS)评分比较了在实施核对表前(基线组)和实施核对表后(干预组)SIC对EICU成人患者的疗效:结果:研究对象患有最常见的合并症,如糖尿病、心肌梗塞、脑血管疾病、中重度肾病、充血性心力衰竭和慢性肺病。基线组和干预组的夏尔森指数中位数没有差异。住院时间中位数为 11.0 天,82.9% 的患者存活至出院。干预组的 DCS 总分低于基线组。三个分量表,包括知情分量表、价值观清晰度分量表和支持分量表在干预组和基线组之间存在显著差异。与基线组相比,干预组患者同意或改变心肺复苏(CPR)想法的人数更少:结论:在 EICU 中使用 SIC 核对表可增加医疗信息披露、患者价值意识和决策支持,从而降低 DCS 分数。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Validation of a checklist to facilitate serious illness conversations in adult emergency in China: a single-centre pilot study.

Background: Advances in emergency and critical care have improved outcomes, but gaps in communication and decision-making persist, especially in the emergency department (ED), prompting the development of a checklist to aid in serious illness conversations (SIC) in China.

Methods: This was a single-centre prospective interventional study on the quality improvement of SIC for life-sustaining treatment (LST). The study recruited patients consecutively for both its observational baseline and interventional stages until its conclusion. Eligible participants were adults over 18 years old admitted to the Emergency Intensive Care Unit (EICU) of a tertiary teaching hospital, possessing full decisional capacity or having a legal proxy. Exclusions were made for pregnant women, patients deceased upon arrival, those who refused participation, and individuals with incomplete data for analysis. First, a two-round Delphi process was organized to identify major elements and generate a standard process through a checklist. Subsequently, the efficacy of SIC in adult patients admitted to the EICU was compared using the Decisional Conflict Scale (DCS) score before (baseline group) and after (intervention group) implementing the checklist.

Results: The study participants presented with the most common comorbidities, such as diabetes, myocardial infarction, cerebrovascular disease, moderate-to-severe renal disease, congestive heart failure, and chronic pulmonary disease. The median Charlson Index did not differ between the baseline and intervention cohorts. The median length of hospital stay was 11.0 days, and 82.9% of patients survived until hospital discharge. The total DCS score was lower in the intervention group than in the baseline group. Three subscales, including the informed, values clarity, and support subscales, demonstrated significant differences between the intervention and baseline groups. Fewer intervention group patients agreed with and changed their minds about cardiopulmonary resuscitation (CPR) compared to the baseline group.

Conclusion: The use of a SIC checklist in the EICU reduced the DCS score by increasing medical information disclosure, patient value awareness, and decision-making support.

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来源期刊
BMC Emergency Medicine
BMC Emergency Medicine Medicine-Emergency Medicine
CiteScore
3.50
自引率
8.00%
发文量
178
审稿时长
29 weeks
期刊介绍: BMC Emergency Medicine is an open access, peer-reviewed journal that considers articles on all urgent and emergency aspects of medicine, in both practice and basic research. In addition, the journal covers aspects of disaster medicine and medicine in special locations, such as conflict areas and military medicine, together with articles concerning healthcare services in the emergency departments.
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