PDF(Pubmed)
Abstract：
A lack of consensus resulting in severe conflicts is often observed between the stakeholders regarding their respective roles in end-of-life (EOL) decision-making in the ICU. Since the burden of these decisions lies upon the individuals, their opinions must be known by medical, judicial, legislative, and governmental authorities. Part of the solution to the issues that arise would be to examine and understand the views of the people in different societies. Hence, in this systematic review, we assessed the attitudes of the physicians, nurses, families, and the general public toward who should be involved in decision-making and influencing factors. Toward this, we searched three electronic databases, i.e., PubMed, CINAHL (Cumulative Index to Nursing & Allied Health), and Embase. A matrix was developed, discussed, accepted, and used for data extraction by two independent investigators. Study quality was evaluated using the Newcastle-Ottawa Scale. Data were extracted by one researcher and double-checked by a second one, and any discrepancies were discussed with a third researcher. The data were analyzed descriptively and synthesized according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Thirty-three studies met our inclusion criteria. Most involved healthcare professionals and reported geographic variations in different timeframes. While paternalistic features have been observed, physicians overall showed an inclination toward collaborative decision-making. Correspondingly, the nursing staff, families, and the public are aligned toward patient and relatives\' participation, with nurses expressing their own involvement as well. Six categories of influencing factors were identified, with high-impact factors, including demographics, fear of litigation, and regulation-related ones. Findings delineate three key points. Firstly, overall stakeholders\' perspectives toward EOL decision-making in the ICU seem to be leaning toward a more collaborative decision-making direction. Secondly, to reduce conflicts and reach a consensus, multifaceted efforts are needed by both healthcare professionals and governmental/regulatory authorities. Finally, due to the multifactorial complexity of the subject, directly related to demographic and regulatory factors, these efforts should be more extensively sought at a regional level.
摘要：
经常观察到利益相关者之间缺乏共识，导致严重冲突，因为他们各自在ICU的报废（EOL）决策中的作用。由于这些决定的负担在于个人，他们的意见必须由医生知道，司法,立法,和政府当局。解决出现的问题的部分方法是审查和理解不同社会中人民的观点。因此，在这次系统审查中，我们评估了医生的态度，护士,家庭,以及公众对谁应该参与决策和影响因素。为此，我们搜索了三个电子数据库,即，PubMed,CINAHL(护理和相关健康累积指数)，和Embase。开发了一个矩阵，讨论,接受,并由两名独立的研究者用于数据提取。使用纽卡斯尔-渥太华量表评估研究质量。数据由一名研究人员提取，并由另一名研究人员双重检查，与第三位研究员讨论了任何差异。根据系统审查和荟萃分析（PRISMA）指南的首选报告项目对数据进行描述性分析和综合。33项研究符合我们的纳入标准。大多数涉及医疗保健专业人员，并报告了不同时间范围内的地理差异。虽然家长式的特征已经被观察到，医生总体上表现出了合作决策的倾向。相应地,护理人员，家庭,公众对病人和亲属的参与是一致的，护士也表达了自己的参与。确定了六类影响因素，具有高影响因素，包括人口统计，害怕诉讼，和监管相关的。调查结果描绘了三个关键点。首先,整体利益相关者对ICU中EOL决策的看法似乎倾向于更协作的决策方向。其次,为了减少冲突并达成共识，医疗保健专业人员和政府/监管机构都需要多方面的努力。最后,由于主题的多因素复杂性，与人口和监管因素直接相关，应该在区域一级更广泛地寻求这些努力。
