目的对诊断为急性肾损伤的危重病人越来越多地采用肾脏替代治疗(RRT)。但最佳启动时间仍不清楚,预后不确定,导致医疗复杂性,伦理冲突,和重症监护病房(ICU)设置中的决策困境。这项研究旨在为危重病人的家庭代孕开发决策辅助(DA),以支持他们与临床医生共同参与决策过程。方法DA的开发采用了以用户为中心的设计(UCD)原则的系统过程,其中包括:(I)竞争分析:搜索,筛选,并评估现有的DA,以收集设计策略的见解,开发技术,和功能;(ii)用户需求评估:访谈家庭代理人,以探索目标用户群体的决策经验并确定他们未满足的需求;(iii)证据综合:整合最新的临床证据和相关信息,以告知DA的内容开发。结果竞争分析包括16个相关数据,我们从现有资源中获得了有价值的见解。在15名家庭代理人中探索了用户决策需求,揭示决策中的四个主题问题,包括陷入困境,不确定感,容量有限,和延迟的决定确认。共有27篇文章用于证据综合。关于疾病和治疗的相关决策知识,如来自决策支持系统或临床指南的文献所述,被格式化为基础知识库。提取了21项证据,并将其整合到RRT的收益和风险内容面板中,可能的结果,以及选择的理由。使用UCD的元素将DA起草成基于网络的照型。该平台可以指导用户通过连续的四步进度进行决策准备:确定治疗方案,权衡收益和风险,澄清个人偏好和价值观,并制定与临床医生正式共同决策的时间表。结论我们开发了DA的快速原型,为ICU中需要RRT的危重患者的家庭代理决策者量身定制。需要未来的研究来评估其可用性,可行性,以及这种干预的临床效果。
Objectives Renal replacement therapy (RRT) is increasingly adopted for critically ill patients diagnosed with acute kidney injury, but the optimal time for initiation remains unclear and prognosis is uncertain, leading to medical complexity, ethical conflicts, and decision dilemmas in intensive care unit (ICU) settings. This study aimed to develop a decision aid (DA) for the family
surrogate of critically ill patients to support their engagement in shared decision-making process with clinicians. Methods Development of DA employed a systematic process with user-centered design (UCD) principle, which included: (i) competitive analysis: searched, screened, and assessed the existing DAs to gather insights for design strategies, developmental techniques, and functionalities; (ii) user needs assessment: interviewed family surrogates in our hospital to explore target user group\'s decision-making experience and identify their unmet needs; (iii) evidence syntheses: integrate latest clinical evidence and pertinent information to inform the content development of DA. Results The competitive analysis included 16 relevant DAs, from which we derived valuable insights using existing resources. User decision needs were explored among a cohort of 15 family surrogates, revealing four thematic issues in decision-making, including stuck into dilemmas, sense of uncertainty, limited capacity, and delayed decision confirmation. A total of 27 articles were included for evidence syntheses. Relevant decision-making knowledge on disease and treatment, as delineated in the literature sourced from decision support system or clinical guidelines, were formatted as the foundational knowledge base. Twenty-one items of evidence were extracted and integrated into the content panels of benefits and risks of RRT, possible outcomes, and reasons to choose. The DA was drafted into a web-based phototype using the elements of UCD. This platform could guide users in their preparation of decision-making through a sequential four-step process: identifying treatment options, weighing the benefits and risks, clarifying personal preferences and values, and formulating a schedule for formal shared decision-making with clinicians. Conclusions We developed a rapid prototype of DA tailored for family
surrogate decision makers of critically ill patients in need of RRT in ICU setting. Future studies are needed to evaluate its usability, feasibility, and clinical effects of this intervention.