PDF(Pubmed)
Abstract：
UNASSIGNED: Potentially inappropriate treatment in critically ill adults is associated with healthcare provider distress and burnout. Knowledge regarding perceived potentially inappropriate treatment amongst pediatric healthcare providers is limited.
UNASSIGNED: Determine the frequency and factors associated with potentially inappropriate treatment in critically ill children as perceived by providers, and describe the factors that providers report contribute to the distress they experience when providing treatment perceived as potentially inappropriate.
UNASSIGNED: Prospective observational mixed-methods study in a single tertiary level PICU conducted between March 2 and September 14, 2018. Patients 0-17 years inclusive with: (1) ≥1 organ system dysfunction (2) moderate to severe mental and physical disabilities, or (3) baseline dependence on medical technology were enrolled if they remained admitted to the PICU for ≥48 h, and were not medically fit for transfer/discharge. The frequency of perceived potentially inappropriate treatment was stratified into three groups based on degree of consensus (1, 2 or 3 providers) regarding the appropriateness of ongoing active treatment per enrolled patient. Distress was self-reported using a 100-point scale.
UNASSIGNED: Of 374 patients admitted during the study, 133 satisfied the inclusion-exclusion criteria. Eighteen patients (unanimous - 3 patients, 2 providers - 7 patients; single provider - 8 patients) were perceived as receiving potentially inappropriate treatment; unanimous consensus was associated with 100% mortality on 3-month follow up post PICU discharge. Fifty-three percent of providers experienced distress secondary to providing treatment perceived as potentially inappropriate. Qualitative thematic analysis revealed five themes regarding factors associated with provider distress: (1) suffering including a sense of causing harm, (2) conflict, (3) quality of life, (4) resource utilization, and (5) uncertainty.
UNASSIGNED: While treatment perceived as potentially inappropriate was infrequent, provider distress was commonly observed. By identifying specific factor(s) contributing to perceived potentially inappropriate treatment and any associated provider distress, organizations can design, implement and assess targeted interventions.
UNASSIGNED: Determine the frequency and factors associated with potentially inappropriate treatment in critically ill children as perceived by providers, and describe the factors that providers report contribute to the distress they experience when providing treatment perceived as potentially inappropriate.
UNASSIGNED: Prospective observational mixed-methods study in a single tertiary level PICU conducted between March 2 and September 14, 2018. Patients 0-17 years inclusive with: (1) ≥1 organ system dysfunction (2) moderate to severe mental and physical disabilities, or (3) baseline dependence on medical technology were enrolled if they remained admitted to the PICU for ≥48 h, and were not medically fit for transfer/discharge. The frequency of perceived potentially inappropriate treatment was stratified into three groups based on degree of consensus (1, 2 or 3 providers) regarding the appropriateness of ongoing active treatment per enrolled patient. Distress was self-reported using a 100-point scale.
UNASSIGNED: Of 374 patients admitted during the study, 133 satisfied the inclusion-exclusion criteria. Eighteen patients (unanimous - 3 patients, 2 providers - 7 patients; single provider - 8 patients) were perceived as receiving potentially inappropriate treatment; unanimous consensus was associated with 100% mortality on 3-month follow up post PICU discharge. Fifty-three percent of providers experienced distress secondary to providing treatment perceived as potentially inappropriate. Qualitative thematic analysis revealed five themes regarding factors associated with provider distress: (1) suffering including a sense of causing harm, (2) conflict, (3) quality of life, (4) resource utilization, and (5) uncertainty.
UNASSIGNED: While treatment perceived as potentially inappropriate was infrequent, provider distress was commonly observed. By identifying specific factor(s) contributing to perceived potentially inappropriate treatment and any associated provider distress, organizations can design, implement and assess targeted interventions.
摘要：
■在危重患者中可能不适当的治疗与医疗保健提供者的痛苦和倦怠有关。关于儿科医疗保健提供者中感知到的潜在不适当治疗的知识是有限的。
■确定提供者认为的与危重患儿潜在不当治疗相关的频率和因素，并描述提供者报告导致他们在提供被认为可能不适当的治疗时所经历的痛苦的因素。
■在2018年3月2日至9月14日进行的单三级PICU的前瞻性观察性混合方法研究。患者0-17岁，包括：（1）≥1个器官系统功能障碍（2）中度至重度精神和身体残疾，或（3）对医疗技术的基线依赖性，如果他们继续入住PICU≥48小时，并且在医学上不适合转移/出院。根据每个入选患者对正在进行的积极治疗的适当性的共识程度（1、2或3个提供者），将感知到的潜在不适当治疗的频率分为三组。使用100点量表自我报告痛苦。
■在研究期间收治的374名患者中，133符合纳入-排除标准。18名患者（一致-3名患者，2个提供者-7名患者；单个提供者-8名患者）被认为接受了潜在的不适当的治疗；在PICU出院后3个月的随访中，一致共识与100％死亡率相关。53％的提供者在提供被认为可能不适当的治疗之后经历了痛苦。定性主题分析揭示了与提供者痛苦相关的五个主题：（1）痛苦，包括造成伤害的感觉，（2）冲突，（3）生活质量，(4)资源利用,（5）不确定性。
■虽然被认为可能不适当的治疗很少见，通常观察到提供者的痛苦。通过确定导致感知到的潜在不当治疗和任何相关提供者困扰的特定因素，组织可以设计，实施和评估有针对性的干预措施。
■确定提供者认为的与危重患儿潜在不当治疗相关的频率和因素，并描述提供者报告导致他们在提供被认为可能不适当的治疗时所经历的痛苦的因素。
■在2018年3月2日至9月14日进行的单三级PICU的前瞻性观察性混合方法研究。患者0-17岁，包括：（1）≥1个器官系统功能障碍（2）中度至重度精神和身体残疾，或（3）对医疗技术的基线依赖性，如果他们继续入住PICU≥48小时，并且在医学上不适合转移/出院。根据每个入选患者对正在进行的积极治疗的适当性的共识程度（1、2或3个提供者），将感知到的潜在不适当治疗的频率分为三组。使用100点量表自我报告痛苦。
■在研究期间收治的374名患者中，133符合纳入-排除标准。18名患者（一致-3名患者，2个提供者-7名患者；单个提供者-8名患者）被认为接受了潜在的不适当的治疗；在PICU出院后3个月的随访中，一致共识与100％死亡率相关。53％的提供者在提供被认为可能不适当的治疗之后经历了痛苦。定性主题分析揭示了与提供者痛苦相关的五个主题：（1）痛苦，包括造成伤害的感觉，（2）冲突，（3）生活质量，(4)资源利用,（5）不确定性。
■虽然被认为可能不适当的治疗很少见，通常观察到提供者的痛苦。通过确定导致感知到的潜在不当治疗和任何相关提供者困扰的特定因素，组织可以设计，实施和评估有针对性的干预措施。
