ICU机械通气患者家属代理决策冲突的 研究进展
Research Progress on Proxy Decision-Making Conflicts of Family Members of ICU Patients with Mechanical Ventilation
DOI: 10.12677/acm.2026.163890, PDF,    科研立项经费支持
作者: 高苗苗, 关 瑶:延安大学医学院护理与健康学院,陕西 延安;牛 倩*:陕西省人民医院儿童病院,陕西 西安;朱亚菲:陕西中医药大学护理学院,陕西 咸阳
关键词: 呼吸重症监护室机械通气代理决策决策冲突共享决策Respiratory Intensive Care Unit Mechanical Ventilation Agency Decision Decision Conflict Shared Decision-Making
摘要: ICU机械通气患者的家属们在决策过程中面临着决策冲突,会对患者的治疗以及代理者的心理产生不良的后果,本文通过对ICU机械通气患者家属代理决策者的决策冲突的概念、评估工具、现状、影响因素以及干预措施等方面进行综述,并提出建议,以期为开展相关研究,减少决策冲突方面提供指导。
Abstract: Objective The family members of ICU patients with mechanical ventilation face decision-making conflicts in the decision-making process, which can have adverse consequences for the treatment of patients and the psychology of agents. This article reviews the concept, assessment tools, current situation, influencing factors and intervention measures of decision-making conflicts among the acting decision-makers of ICU patients with mechanical ventilation, and puts forward suggestions. In order to provide guidance for conducting relevant research and reducing decision-making conflicts.
文章引用:高苗苗, 牛倩, 朱亚菲, 关瑶. ICU机械通气患者家属代理决策冲突的 研究进展[J]. 临床医学进展, 2026, 16(3): 1141-1149. https://doi.org/10.12677/acm.2026.163890

参考文献

[1] Pham, T., Brochard, L.J. and Slutsky, A.S. (2017) Mechanical Ventilation: State of the Art. Mayo Clinic Proceedings, 92, 1382-1400. [Google Scholar] [CrossRef] [PubMed]
[2] Esteban, A. (2002) Characteristics and Outcomes in Adult Patients Receiving Mechanical Ventilationa 28-Day International Study. JAMA, 287, 345-355. [Google Scholar] [CrossRef] [PubMed]
[3] Thille, A.W., Cortés-Puch, I. and Esteban, A. (2013) Weaning from the Ventilator and Extubation in ICU. Current Opinion in Critical Care, 19, 57-64. [Google Scholar] [CrossRef] [PubMed]
[4] Chelluri, L., Im, K.A., Belle, S.H., Schulz, R., Rotondi, A.J., Donahoe, M.P., et al. (2004) Long-Term Mortality and Quality of Life after Prolonged Mechanical Ventilation. Critical Care Medicine, 32, 61-69. [Google Scholar] [CrossRef] [PubMed]
[5] Cai, X., Robinson, J., Muehlschlegel, S., White, D.B., Holloway, R.G., Sheth, K.N., et al. (2015) Patient Preferences and Surrogate Decision Making in Neuroscience Intensive Care Units. Neurocritical Care, 23, 131-141. [Google Scholar] [CrossRef] [PubMed]
[6] Zhu, X. and Lu, G. (2024) Research Status and Inspiration on Decision-Making Dilemmas on Family Members of Intensive Care Unit Patients. Chinese Medical Ethics, 37, 168-176.
[7] Zheng, M., Yin, C., Cao, Y., Zhang, Y., Zhang, K., Zhang, X., et al. (2021) Development and Evaluation of a Decision Aid for Family Surrogate Decision-Makers for Patients with Acute Kidney Injury Requiring Renal Replacement Therapy (RRT) in ICUs: A Study Protocol. BMJ Open, 11, e043385. [Google Scholar] [CrossRef] [PubMed]
[8] Hong, P., Gorodzinsky, A.Y., Taylor, B.A. and Chorney, J.M. (2016) Parental Decision Making in Pediatric Otoplasty: The Role of Shared Decision Making in Parental Decisional Conflict and Decisional Regret. The Laryngoscope, 126, S5-S13. [Google Scholar] [CrossRef] [PubMed]
[9] Janis, I.L. and Mann, L. (1977) Decision Making: A Psychological Analysis of Conflict, Choice, and Commitment. Free Press, 488 p.
[10] Sim, J.A., Shin, J.S., Park, S.M., Chang, Y.J., Shin, A., Noh, D.Y., et al. (2015) Association between Information Provision and Decisional Conflict in Cancer Patients. Annals of Oncology, 26, 1974-1980. [Google Scholar] [CrossRef] [PubMed]
[11] O’Connor, A.M. (1995) Validation of a Decisional Conflict Scale. Medical Decision Making, 15, 25-30. [Google Scholar] [CrossRef] [PubMed]
[12] 王露, 陈英, 崔金锐, 等. 中文版决策冲突量表在直肠癌患者术式决策中应用的信效度检验[J]. 护理学杂志, 2019, 34(3): 31-35.
[13] 廖宗峰, 李玲, 黄姝, 等. 家属决策冲突量表在神经内科ICU患者家属中应用的信效度检验[J]. 神经损伤与功能重建, 2021, 16(11): 636-639.
[14] Hickman, R.L., Pignatiello, G.A. and Tahir, S. (2017) Evaluation of the Decisional Fatigue Scale among Surrogate Decision Makers of the Critically Ill. Western Journal of Nursing Research, 40, 191-208. [Google Scholar] [CrossRef] [PubMed]
[15] 潘国翠, 李梅. 决策疲劳量表的汉化及其应用于ICU患者家属的信度效度评价[J]. 护理学报, 2020, 27(12): 38-41.
[16] 王露梦, 韩文娟, 万腾飞, 等. 呼吸重症监护室机械通气患者代理决策者决策冲突发生及影响因素分析[J]. 陆军军医大学学报, 2025, 47(9): 995-1002.
[17] Hayashi, L.Y., Gazzotti, M.R., Vidotto, M.C. and Jardim, J.R. (2013) Incidence, Indication and Complications of Postoperative Reintubation after Elective Intracranial Surgery. Sao Paulo Medical Journal, 131, 158-165. [Google Scholar] [CrossRef] [PubMed]
[18] Casey, J.D., Vaughan, E.R., Lloyd, B.D., Bilas, P.A., Hall, E.J., Toporek, A.H., et al. (2019) Protocolized Post-Extubation Respiratory Support to Prevent Reintubation: Protocol and Statistical Analysis Plan for a Clinical Trial. BMJ Open, 9, e030476. [Google Scholar] [CrossRef] [PubMed]
[19] Hernández, G., Vaquero, C., Colinas, L., Cuena, R., González, P., Canabal, A., et al. (2016) Effect of Postextubation High-Flow Nasal Cannula vs Noninvasive Ventilation on Reintubation and Postextubation Respiratory Failure in High-Risk Patients: A Randomized Clinical Trial. JAMA, 316, 1565-1574. [Google Scholar] [CrossRef] [PubMed]
[20] Chiarchiaro, J., Buddadhumaruk, P., Arnold, R.M. and White, D.B. (2015) Prior Advance Care Planning Is Associated with Less Decisional Conflict among Surrogates for Critically Ill Patients. Annals of the American Thoracic Society, 12, 1528-1533. [Google Scholar] [CrossRef] [PubMed]
[21] 干贝贝, 李恩生, 庄丹雯. 重症监护室患者家属决策冲突现状及影响因素分析[J]. 中国医药导报, 2024, 21(15): 42-44.
[22] 祁聪慧, 康凤英, 赵文芳, 等. CRRT病人上机前家属决策冲突现状及影响因素[J]. 护理研究, 2023, 37(10): 1870-1874.
[23] 崔梦娇, 黄萍, 王芳, 等. 重症患者代理决策者生命支持决策体验质性研究的Meta整合[J]. 护理学杂志, 2024, 39(23): 87-92.
[24] Scheunemann, L.P., Cunningham, T.V., Arnold, R.M., Buddadhumaruk, P. and White, D.B. (2015) How Clinicians Discuss Critically Ill Patients’ Preferences and Values with Surrogates. Critical Care Medicine, 43, 757-764. [Google Scholar] [CrossRef] [PubMed]
[25] 赵丽华, 屈欢, 李娇娇, 等. 晚期癌症患者的替代决策者姑息照护决策冲突的调查研究[J]. 中华护理杂志, 2022, 57(14): 1683-1690.
[26] 李成成. 基于渥太华决策支持框架构建恶性肿瘤合并呼吸衰竭患者有创呼吸支持决策辅助工具[D]: [硕士学位论文]. 成都: 成都医学院, 2025.
[27] Edwards, J.D., Panitch, H.B., George, M., Cirrilla, A., Grunstein, E., Wolfe, J., et al. (2020) Development and Validation of a Novel Informational Booklet for Pediatric Long‐Term Ventilation Decision Support. Pediatric Pulmonology, 56, 1198-1204. [Google Scholar] [CrossRef] [PubMed]
[28] So, I.C. (2023) Decisional Conflict in Parents of Children with Congenital Heart Defect: Towards Development of a Model. International Journal of Nursing Practice, 30, e13152. [Google Scholar] [CrossRef] [PubMed]
[29] 袁冶, 范雪娇, 吴涛. 社会支持对早期乳腺癌患者手术方式决策冲突的影响: 自我效能和积极应对的中介作用分析[J]. 现代医学, 2025, 53(5): 761-766.
[30] Bandura, A. (1977) Self-Efficacy: Toward a Unifying Theory of Behavioral Change. Psychological Review, 84, 191-215. [Google Scholar] [CrossRef
[31] Bandura, A. (1982) Self-Efficacy Mechanism in Human Agency. American Psychologist, 37, 122-147. [Google Scholar] [CrossRef
[32] Bunn, H. and O’Connor, A. (1996) Validation of Client Decision-Making Instruments in the Context of Psychiatry. Canadian Journal of Nursing Research Archive, 28, 13-27.
[33] Lichtenthal, W.G., Viola, M., Rogers, M., Roberts, K.E., Lief, L., Cox, C.E., et al. (2021) Development and Preliminary Evaluation of EMPOWER for Surrogate Decision-Makers of Critically Ill Patients. Palliative and Supportive Care, 20, 167-177. [Google Scholar] [CrossRef] [PubMed]
[34] Bibas, L., Peretz-Larochelle, M., Adhikari, N.K., Goldfarb, M.J., Luk, A., Englesakis, M., et al. (2019) Association of Surrogate Decision-Making Interventions for Critically Ill Adults with Patient, Family, and Resource Use Outcomes: A Systematic Review and Meta-Analysis. JAMA Network Open, 2, e197229. [Google Scholar] [CrossRef] [PubMed]
[35] Wu, F., Zhuang, Y., Chen, X., Wen, H., Tao, W., Lao, Y., et al. (2020) Decision‐Making among the Substitute Decision Makers in Intensive Care Units: An Investigation of Decision Control Preferences and Decisional Conflicts. Journal of Advanced Nursing, 76, 2323-2335. [Google Scholar] [CrossRef] [PubMed]
[36] Breen, C.M., Abernethy, A.P., Abbott, K.H. and Tulsky, J.A. (2001) Conflict Associated with Decisions to Limit Life-Sustaining Treatment in Intensive Care Units. Journal of General Internal Medicine, 16, 283-289. [Google Scholar] [CrossRef] [PubMed]
[37] Connors, A.F. (1995) A Controlled Trial to Improve Care for Seriously III Hospitalized Patients: The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUP-PORT). JAMA, 274, 1591-1598. [Google Scholar] [CrossRef
[38] Kross, E.K., Engelberg, R.A., Gries, C.J., Nielsen, E.L., Zatzick, D. and Curtis, J.R. (2011) ICU Care Associated with Symptoms of Depression and Posttraumatic Stress Disorder among Family Members of Patients Who Die in the ICU. Chest, 139, 795-801. [Google Scholar] [CrossRef] [PubMed]
[39] Yoo, S.H., Yun, Y.H., Kim, K., Lee, J.L., Park, J., Choi, Y.S., et al. (2018) The Impact of Caregiver’s Role Preference on Decisional Conflicts and Psychiatric Distresses in Decision Making to Help Caregiver’s Disclosure of Terminal Disease Status. Quality of Life Research, 27, 1571-1581. [Google Scholar] [CrossRef] [PubMed]
[40] Braun, U.K., Beyth, R.J., Ford, M.E. and McCullough, L.B. (2008) Voices of African American, Caucasian, and Hispanic Surrogates on the Burdens of End-Of-Life Decision Making. Journal of General Internal Medicine, 23, 267-274. [Google Scholar] [CrossRef] [PubMed]
[41] Bailey, R.A., Pfeifer, M., Shillington, A.C., Harshaw, Q., Funnell, M.M., VanWingen, J., et al. (2015) Effect of a Patient Decision Aid (PDA) for Type 2 Diabetes on Knowledge, Decisional Self-Efficacy, and Decisional Conflict. BMC Health Services Research, 16, Article No. 10. [Google Scholar] [CrossRef] [PubMed]
[42] 马小川, 王建光. ICU治疗领域的伦理问题辨析[J]. 医学与哲学(A), 2017, 38(5): 17-20, 30.
[43] October, T.W., Jones, A.H., Greenlick Michals, H., Hebert, L.M., Jiang, J. and Wang, J. (2020) Parental Conflict, Regret, and Short-Term Impact on Quality of Life in Tracheostomy Decision-Making. Pediatric Critical Care Medicine, 21, 136-142. [Google Scholar] [CrossRef] [PubMed]
[44] Kunneman, M. and Montori, V.M. (2016) When Patient-Centred Care Is Worth Doing Well: Informed Consent or Shared Decision-Making. BMJ Quality & Safety, 26, 522-524. [Google Scholar] [CrossRef] [PubMed]
[45] 朱懿珍, 张爽, 关玉珠, 等. 共享决策在ICU中的应用进展[J]. 中华护理杂志, 2021, 56(2): 289-294.
[46] 孙绪灿, 黎张双子, 李鑫, 等. ICU患者替代决策者决策疲劳、决策冲突与共享决策的现况调查[J]. 护理学杂志, 2025, 40(6): 81-86.
[47] 翁冰冰, 陈文, 蒋虹丽. 医患共同决策模型及实践应用进展[J]. 医学与哲学, 2023, 44(5): 21-25.
[48] Wubben, N., van den Boogaard, M., van der Hoeven, J. and Zegers, M. (2021) Shared Decision-Making in the ICU from the Perspective of Physicians, Nurses and Patients: A Qualitative Interview Study. BMJ Open, 11, e050134. [Google Scholar] [CrossRef] [PubMed]
[49] Dales, R.E., O’Connor, A., Hebert, P., Sullivan, K., Mc Kim, D. and Llewellyn-Thomas, H. (1999) Intubation and Mechanical Ventilation for COPD: Development of an Instrument to Elicit Patient Preferences. Chest, 116, 792-800. [Google Scholar] [CrossRef] [PubMed]
[50] Stacey, D., Légaré, F., Lewis, K., et al. (2017) Decision Aids for People Facing Health Treatment or Screening Decisions. The Cochrane Database of Systematic Reviews, 1, CD001431.https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001431.pub5/full [Google Scholar] [CrossRef