影响重症监护病房多学科临床决策的因素：系统回顾和混合方法综合

BJA open Pub Date : 2025-09-25 DOI:10.1016/j.bjao.2025.100488

Kenki Matsumoto , Brigitta Fazzini , Hannah Malcolm , Jack Eldridge , Zudin Puthucheary , Magda Osman , Timothy J. Stephens

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引用次数: 0

摘要

重症监护病房（ICU）是一个动态的环境，需要每天就器官支持治疗做出临床决定。即使存在国际公认的治疗指导，临床医生（即医生、护士和联合医疗从业人员）之间的决策过程也存在显著差异。影响临床决策的因素和过程尚不清楚。本系统综述旨在通过评估当前关于ICU器官支持治疗决策过程和影响决策因素的证据，建立一个决策模型。方法系统检索PubMed、Embase和CINAHL三个数据库，包括所有探讨影响器官支持决策因素的论文（PROSPERO: CRD42021283290）。进行混合方法元综合，以生成用于生成决策模型的不同主题和子主题。结果经筛选8967份记录，33项研究符合纳入标准，纳入分析。对数据的混合方法解释发现，决策可以是线性的，主要由患者因素（即患者的临床参数）决定。然而，该分析确定了11个影响临床医生决策的因素。四个主题：1)人，2)团队，3)系统和4)患者成为优化决策过程的潜在可修改因素。结论围绕器官支持治疗的决策是复杂的、动态的。然而，有四个不同的潜在可修改的主题，影响多学科决策过程。进一步的研究应侧重于了解干预措施以改善决策，以及不同的决策过程是否直接影响患者的预后。系统评价协议prospero （CRD42021283290）。

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Factors influencing multidisciplinary clinical decision-making in the critical care unit: a systematic review and mixed-methods meta-synthesis

Background

The intensive care unit (ICU) is a dynamic environment that necessitates daily clinical decisions regarding organ support treatments. The decision-making process varies significantly between clinicians (i.e. doctors, nurses, and allied healthcare practitioners), even where internationally accepted treatment guidance exists. The factors and the processes influencing clinical decision-making are poorly understood. This systematic review aims to generate a decision-making model by evaluating current evidence on the decision-making process and the factors that affect decisions on organ support treatments in the ICU.

Methods

We conducted a systematic search on three databases (PubMed, Embase, and CINAHL) including all papers exploring factors that influenced organ support decisions (PROSPERO: CRD42021283290). A mixed-methods meta-synthesis was performed to enable the generation of distinct themes and subthemes used to generate the decision-making model.

Results

After screening 8967 records, 33 studies met the inclusion criteria and were included in the analysis. The mixed-method interpretation of the data found that decision-making can be linear and primarily dictated by patient factors (i.e. patient’s clinical parameters). However, the analysis identified 11 factors that can influence and strain clinician’s decision-making. Four themes: 1) human, 2) team, 3) system, and 4) patient emerged as the potential modifiable factors to optimise the decision-making process.

Conclusions

Decision-making surrounding organ support treatment is complex and dynamic. However, there are four distinctive potentially modifiable themes that influence the multidisciplinary decision-making process. Further studies should focus on understanding interventions to improve decision-making and if different decision-making processes directly affect patients’ outcomes.