代理决策的压力:促成因素和临床医生在缓解压力中的作用。

IF 1.5 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES American Journal of Hospice & Palliative Medicine Pub Date : 2024-08-01 Epub Date: 2023-09-13 DOI:10.1177/10499091231198750
Adrienne D Mishkin, Nicole C Allen, Stephanie G Cheung, Maria Carla Faccini, Lauren S Flicker, Daniel Shalev
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引用次数: 0

摘要

背景:在为重症成人患者做决策时,经常会使用代理决策者(surrogate decision-Makers)。关于代理决策者的经历、压力和减轻压力的潜力,目前还没有足够的数据:匿名在线调查询问了(1)医疗状况(2)总压力(3)人口统计学(4)潜在因素,包括有关患者意愿的信息来源、外部支持来源或竞争压力源,以及他们在整个经历中与医疗团队的互动:108 名受访者参与了调查,其中 91 人完成了所有项目。大多数受访者将其作为代理人的经历列为其一生中压力最大的经历之一;这与是否是临终决定(P = .003)、受访者宗教信仰(P = .015)或宗教或精神信仰(P = .024)以及自身健康问题(P = .008)有关。在单个 Likert 反应中,当代治者认为他们提供了帮助 (P < .001)、了解患者的意愿 (P=.0011)、专门讨论了患者的意愿 (P < .001) 或患者的意愿被记录在案 (P < .001) 时,他们的压力会明显减轻。关于代理团队互动的项目也达到了显著性水平,包括医生善于沟通和随叫随到(P<.001)、尊重(P=.007)、诚实(P<.001)和验证(P=.001):代孕压力是一个不断发展的研究领域。重要因素包括与医疗团队的关系,这使得 HPM 在减轻代理压力方面发挥重要作用。
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The Stresses of Surrogate Decision-Making: Contributing Factors and Clinicians' Role in Mitigation.

Background: Surrogate Decision-Makers (surrogates) are frequently employed in decision-making for critically ill adults. There are insufficient data considering the surrogate experience, stress, and potential for mitigation.

Methods: An anonymous online survey queried (1) medical situation (2) total stress (3) demographics (4) potential factors, including sources of information about patient wishes, external sources of support or competing stressors, and their interactions with the medical team through the experience.

Results: 108 respondents were included; 91 completed all items. Most respondents ranked their experience as a surrogate as one of the most stressful experiences of their lives; this was associated with whether it was an end-of-life decision (P = .003), Respondent Religion (P = .015), or religious or spiritual beliefs (P = .024), and having their own health problems (P = .008). On individual Likert responses, surrogates reported significant stress mitigation when they felt they had been helpful (P < .001), knew the patient's wishes (P = .0011), specifically discussed patient wishes (P < .001), or patient's wishes were documented (P < .001). Items about surrogate-team interaction also met significance, including the physician being communicative and available (P < .001), respectful (P = .007), honest (P < .001), and validating (P = .001).

Conclusions: Surrogate stress is an evolving area for research. Significant factors included relationship with the medical team, making this an important area for HPM to play a key role in mitigating surrogate stress.

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来源期刊
American Journal of Hospice & Palliative Medicine
American Journal of Hospice & Palliative Medicine HEALTH CARE SCIENCES & SERVICES-
CiteScore
3.80
自引率
5.30%
发文量
169
审稿时长
6-12 weeks
期刊介绍: American Journal of Hospice & Palliative Medicine (AJHPM) is a peer-reviewed journal, published eight times a year. In 30 years of publication, AJHPM has highlighted the interdisciplinary team approach to hospice and palliative medicine as related to the care of the patient and family. This journal is a member of the Committee on Publication Ethics (COPE).
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