ICU患者家属代理决策干预方案的范围综述

牛海娇; 栾丽娜; 朱劲松

doi:10.16460/j.issn2097-6569.2025.13.032

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护理学报 ›› 2025, Vol. 32 ›› Issue (13) : 32-38. DOI: 10.16460/j.issn2097-6569.2025.13.032

循证护理

ICU患者家属代理决策干预方案的范围综述

牛海娇¹, 栾丽娜¹, 朱劲松²

作者信息 +

Interventions for surrogate decision-making by families of ICU patients: a scoping review

NIU Haijiao¹, LUAN Lina¹, ZHU Jinsong²

Author information +

文章历史 +

摘要

目的本文旨在对ICU患者家属代理决策的干预性研究进行系统的范围综述,归纳和总结现有干预的内容、形式、结局指标及干预效果,为相关研究和临床实践提供参考依据。方法通过系统检索中国知网、万方、维普、中国生物医学文献数据库、Pubmed、Embase、Web of Science、Ovid、EBSCO、Cochrane Library等多个数据库,检索时间范围为数据库建库至2024年7月20日。经过严格的文献筛选与数据提取,归纳总结了相关研究的结果与结论。结果共纳入31项研究。研究的干预内容主要涵盖心理干预和决策信息提供2个层面。干预形式包括线上决策辅助工具、家庭会议、预先护理计划设置、决策清单发放及信息手册提供等。干预效果的评价维度包括代理决策者心理状况、代理决策工具使用效果、代理决策实施效果以及对ICU患者健康结局的影响。结论现有研究表明,ICU患者家属代理决策干预方案具有较高的可行性,但其实际应用效果仍需进一步深入分析。干预方案形式多元,未来应结合代理决策者的个体特征,进行个性化方案的设计与实施。

Abstract

Objective To conduct a scoping review of research on interventions for surrogate decision-making by families of ICU patients, and to summarize the content and form of intervention, outcome and intervention effect. Methods China National Knowledge Network (CNKI), Wanfang, VIP database, China Biomedical Abstracted Database, Pubmed, Embase, Web of Science, Ovid, EBSCO and Cochrane Library were searched for related literature from the inception of databases to July 20, 2024. The data were screened and extracted, and the search results were standardized and reported. Results Thirty-one studies were included. The content of surrogate decision-making included psychological intervention and decision information. The main forms of intervention were online decision aid tools, family meetings, advance care planning, decision lists and information manuals. The evaluation of intervention effect included psychological assessment of surrogate decision maker, effectiveness of surrogate decision-making tools, implementation effect of surrogate decision-making and effect of surrogate decision-making on health outcome of ICU patients. Conclusion Surrogate decision intervention scheme for family members of ICU patients is highly feasible, but its practical effect needs to be further verified. The interventions are diverse in form. In the future, personalized intervention designs and implementation should be tailored to the individual characteristics of surrogate decision-makers.

导出引用

牛海娇, 栾丽娜, 朱劲松. ICU患者家属代理决策干预方案的范围综述[J]. 护理学报. 2025, 32(13): 32-38 https://doi.org/10.16460/j.issn2097-6569.2025.13.032

NIU Haijiao, LUAN Lina, ZHU Jinsong. Interventions for surrogate decision-making by families of ICU patients: a scoping review[J]. Journal of Nursing. 2025, 32(13): 32-38 https://doi.org/10.16460/j.issn2097-6569.2025.13.032

中图分类号： R473

参考文献

[1] Comer AR, Gaffney M, Stone CL, et al.Physician understanding and application of surrogate decision-making laws in clinical practice[J].AJOB Empir Bioeth,2017, 8(3): 198-204. DOI: 10.1080/23294515.2016.1234520.
[2] 张小莉,杨鑫玉,肖宇,等.晚期癌症患者代理决策者安宁疗护决策后悔研究的范围综述[J].护理学报,2024,31(8):49-54.DOI:10.16460/j.issn1008-9969.2024.08.049.
[3] Dionne-Odom JN, White DB.Reconceptualizing how to support surrogates making medical decisions for critically ill patients[J].JAMA,2021, 325(21): 2147-2148. DOI: 10.1001/jama.2021.6445.
[4] Peters MD, Godfrey CM, Khalil H, et al.Guidance for conducting systematic scoping reviews[J].Int J Evid Based Healthc, 2015,13(3):141-146.DOI:10.1097/XEB.0000000000000050.
[5] Lichtenthal WG, Lief L, Rogers M, et al.EMPOWER: a multi-site pilot trial to reduce distress in surrogate decision-makers in the ICU[J].J Pain Symptom Manage,2024, 67(6): 512-524.e2. DOI: 10.1016/j.jpainsymman.2024.03.002.
[6] Ge H, Li S, Ma Q.Validation of a checklist to facilitate serious illness conversations in adult emergency in China: a single-centre pilot study[J].BMC Emerg Med,2024, 24(1):144. DOI: 10.1186/s12873-024-01065-z.
[7] Torke AM, Varner-Perez SE, Burke ES, et al.Effects of spiritual care on well-being of intensive care family surrogates:a clinical trial[J].J Pain Symptom Manage,2023, 65(4): 296-307. DOI: 10.1016/j.jpainsymman.2022.12.007.
[8] Muehlschlegel S, Goostrey K, Flahive J, et al.Pilot randomized clinical trial of a goals-of-care decision aid for surrogates of patients with severe acute brain injury[J]. Neurology,2022, 99(14): e1446-e1455. DOI: 10.1212/WNL.0000000000200937.
[9] Kentish-Barnes N, Chevret S, Valade S, et al.A three-step support strategy for relatives of patients dying in the intensive care unit: a cluster randomised trial[J].Lancet,2022, 399(10325):656-664. DOI: 10.1016/S0140-6736(21)02176-0.
[10] Howard M, Elston D, Borhan S, et al.Randomised trial of a serious illness decision aid (plan well guide) for patients and their substitute decision-makers to improve engagement in advance care planning[J].BMJ Support Palliat Care,2022, 12(1):99-106. DOI: 10.1136/bmjspcare-2021-003040.
[11] Chen C, Sullivan SS, Lorenz RA, et al.Comfprt communication in the ICU: pilot test of a nurse-led communication intervention for surrogates[J].J Clin Nurs,2022, 31(21-22): 3076-3088. DOI: 10.1111/jocn.16132.
[12] Thiede E, Levi BH, Lipnick D, et al.Effect of advance care planning on surrogate decision makers’ preparedness for decision making: results of a mixed-methods randomized controlled trial[J].J Palliat Med,2021, 24(7):982-993. DOI: 10.1089/jpm.2020.0238.
[13] Suen AO, Butler RA, Arnold RM, et al.A pilot randomized trial of an interactive web-based tool to support surrogate decision makers in the intensive care unit[J]. Ann Am Thorac Soc,2021, 18(7): 1191-1201. DOI: 10.1513/AnnalsATS.202006-585OC.
[14] Robin S, Labarriere C, Sechaud G, et al.Information pamphlet given to relatives during the end-of-life decision in the ICU: an assessor-blinded, randomized controlled trial[J].Chest,2021,159(6):2301-2308. DOI: 10.1016/j.chest.2021.01.072.
[15] Ferrer Marrero TM, Barash M, Jaber B, et al.The impact of a cardiopulmonary resuscitation video on reducing surrogates’ anxiety: a pilot randomized controlled trial[J].J Crit Care,2021, 62: 235-242. DOI: 10.1016/j.jcrc.2020.11.001.
[16] Greenberg JA, Gerhart J, Horst JN, et al.A multidisciplinary team-based approach to improve communication with surrogates of patients with chronic critical illness[J].Am J Hosp Palliat Care, 2020, 37(3): 214-221. DOI: 10.1177/1049909119876606.
[17] Krones T, Budilivschi A, Karzig I, et al.Advance care planning for the severely ill in the hospital: a randomized trial[J].BMJ Support Palliat Care,2019, 12(e3): e411-23. DOI: 10.1136/bmjspcare-2017-001489.
[18] Cox CE, White DB, Hough CL, et al.Effects of a personalized web-based decision aid for surrogate decision makers of patients with prolonged mechanical ventilation: a randomized clinical trial[J].Ann Intern Med,2019,170(5): 285-297. DOI: 10.7326/M18-2335.
[19] White DB, Angus DC, Shields AM, et al.A randomized trial of a family-support intervention in intensive care units[J].N Engl J Med,2018, 378(25): 2365-2375. DOI: 10.1056/NEJMoa1802637.
[20] Green MJ, Van Scoy LJ, Foy AJ, et al.A randomized controlled trial of strategies to improve family members’ preparedness for surrogate decision-making[J]. Am J Hosp Palliat Care, 2018, 35(6):866-874. DOI:10.1177/1049909117744554.
[21] Turnbull AE, Chessare CM, Coffin RK, et al.A brief intervention for preparing ICU families to be proxies: a phase I study[J].PLoS One,2017, 12(10): e0185483. DOI: 10.1371/journal.pone.0185483.
[22] Sulmasy DP, Hughes MT, Yenokyan G, et al.The Trial of Ascertaining Individual preferences for Loved Ones’ Role in End-of-Life Decisions (TAILORED) study: a randomized controlled trial to improve surrogate decision making[J].J Pain Symptom Manage, 2017, 54(4):455-465. DOI: 10.1016/j.jpainsymman.2017.07.004.
[23] Torke AM, Wocial LD, Johns SA, et al.The family navigator: a pilot intervention to support intensive care unit family surrogates[J].Am J Crit Care,2016, 25(6):498-507. DOI: 10.4037/ajcc2016730.
[24] Curtis JR, Treece PD, Nielsen EL, et al.Randomized trial of communication facilitators to reduce family distress and intensity of end-of-life Care[J].Am J Respir Crit Care Med,2016, 193(2):154-162.DOI:10.1164/rccm.201505-0900OC.
[25] Carson SS, Cox CE, Wallenstein S, et al.Effect of palliative care-led meetings for families of patients with chronic critical illness: a randomized clinical trial[J].JAMA,2016, 316(1):51-62. DOI: 10.1001/jama.2016.8474.
[26] Wilson ME, Krupa A, Hinds RF, et al.A video to improve patient and surrogate understanding of cardiopulmonary resuscitation choices in the ICU: a randomized controlled trial[J].Crit Care Med,2015, 43(3):621-629. DOI: 10.1097/CCM.0000000000000749.
[27] Song MK, Ward SE, Fine JP, et al.Advance care planning and end-of-life decision making in dialysis: a randomized controlled trial targeting patients and their surrogates[J].Am J Kidney Dis,2015, 66(5):813-822. DOI: 10.1053/j.ajkd.2015.05.018.
[28] Mccannon JB, O’donnell WJ, Thompson BT, et al.Augmenting communication and decision making in the intensive care unit with a cardiopulmonary resuscitation video decision support tool: a temporal intervention study[J]. J Palliat Med, 2012, 15(12):1382-1387. DOI:10.1089/jpm.2012.0215.
[29] Cox CE, Lewis CL, Hanson LC, et al.Development and pilot testing of a decision aid for surrogates of patients with prolonged mechanical ventilation[J]. Crit Care Med,2012, 40(8):2327-2334. DOI:10.1097/CCM.0b013e3182536a63.
[30] Lee Char SJ, Evans LR, Malvar GL, et al.A randomized trial of two methods to disclose prognosis to surrogate decision makers in intensive care units[J]. Am J Respir Crit Care Med,2010, 182(7):905-909.DOI:10.1164/rccm.201002-0262OC.
[31] Lautrette A, Darmon M, Megarbane B, et al.A communication strategy and brochure for relatives of patients dying in the ICU[J].N Engl J Med,2007, 356(5):469-478. DOI:10.1056/NEJMoa063446.
[32] Song MK, Kirchhoff KT, Douglas J, et al.A randomized, controlled trial to improve advance care planning among patients undergoing cardiac surgery[J].Med Care,2005, 43(10):1049-1053. DOI: 10.1097/01.mlr.0000178192.10283.b4.
[33] Briggs LA, Kirchhoff KT, Hammes BJ, et al.Patient-centered advance care planning in special patient populations: a pilot study[J].J Prof Nurs,2004, 20(1):47-58. DOI:10.1016/j.profnurs.2003.12.001.
[34] Schneiderman LJ, Gilmer T, Teetzel HD, et al.Effect of ethics consultations on nonbeneficial life-sustaining treatments in the intensive care setting: a randomized controlled trial[J].Jama,2003, 290(9):1166-1172. DOI:10.1001/jama.290.9.1166.
[35] Azoulay E, Pochard F, Chevret S, et al.Impact of a family information leaflet on effectiveness of information provided to family members of intensive care unit patients: a multicenter, prospective, randomized, controlled trial[J].Am J Respir Crit Care Med,2002, 165(4):438-442. DOI:10.1164/ajrccm.165.4.200108-006oc.
[36] Shah RD, Rasinski KA, Alexander GC.The Influence of surrogate decision makers on clinical decision making for critically ill adults[J].J Intensive Care Med,2015, 30(5): 278-285. DOI:10.1177/0885066613516597.
[37] Baltazar AO, Popejoy L.Health Literacy of surrogates and communication issues in palliative care conversations in critical care: an integrative review[J].J Hosp Palliat Nurs,2023, 25(1):39-44.DOI:10.1097/NJH.0000000000000921.
[38] Sun WN, Kao CY.The challenges in using eHealth decision resources for surrogate decision-making in the intensive care unit[J].J Med Internet Res,2024, 26:e47017. DOI:10.2196/47017.
[39] Sullivan DR, Slatore CG.Advance care planning. Does it benefit surrogate decision makers in the intensive care unit?[J].Ann Am Thorac Soc,2015, 12(10):1432-1433. DOI: 10.1513/AnnalsATS.201508-488ED.
[40] 黎东梅,陈锦丽,李丽,等.300名慢性病患者代理决策者预立医疗照护计划参与现状及影响因素分析[J].护理学报,2023,30(2):67-72.DOI:10.16460/j.issn1008-9969.2023.02.067.
[41] Rosa WE, Izumi S, Sullivan DR, et al.Advance care planning in serious illness: a narrative review[J].J Pain Symptom Manage,2023,65(1):e63-e78. DOI:10.1016/j.jpainsymman.2022.08.012.
[42] Sui W, Gong X, Qiao X, et al.Family members’ perceptions of surrogate decision-making in the intensive care unit: a systematic review[J]. Int J Nurs Stud,2023(137):104391. DOI: 10.1016/j.ijnurstu.2022.104391.
[43] Ervin JN.Communication expectations of critically ill patients and their families[J].J Emerg Crit Care Med,2019(3):48. DOI:10.21037/jeccm.2019.09.02.