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  

Decision fatigue,decisional conflict,and shared decision-making among surrogate decision makers of ICU patients

作　　者：孙绪灿 黎张双子 李鑫 韩亚贤 徐傲然 陈志明 Sun Xucan;Li Zhangshuangzi;Li Xin;Han Yaxian;Xu Aoran;Chen Zhiming(Nursing School of Guizhou Medical University,Guiyang 550004,China)

机构地区：[1]贵州医科大学护理学院,贵州贵阳550004 [2]清镇市第一人民医院ICU [3]贵州医科大学附属医院儿科 [4]中山大学附属第一医院贵州医院护理部

出　　处：《护理学杂志》2025年第6期81-86,共6页Journal of Nursing Science

基　　金：贵州省卫生健康委科学技术基金项目(gzwkj2024-256)。

摘　　要：目的 探讨ICU患者替代决策者决策疲劳、决策冲突与共享决策的现况及影响因素,为制订更符合患者需求的共享决策方案提供参考。方法 采用便利抽样法,选取192名ICU患者的替代决策者为研究对象,使用一般资料调查表、决策疲劳量表、决策冲突量表、共享决策问卷进行调查。结果 ICU患者替代决策者决策疲劳得分为(22.15±6.17)分,决策冲突(41.55±14.00)分,共享决策(78.47±12.86)分。决策冲突与共享决策呈负相关(P<0.05)。替代决策者月收入、是否与患者同住、患者APACHEⅡ评分是其决策疲劳的影响因素,APACHEⅡ评分是决策冲突的影响因素,患者费用支付方式是共享决策的影响因素(均P<0.05)。结论 ICU患者替代决策者的决策疲劳和决策冲突处于较高水平,共享决策处于中等水平。医护人员应关注替代决策者发生决策疲劳和决策冲突的因素,鼓励其参与共享决策,降低决策疲劳和决策冲突。Objective To determine the levels and influencing factors of decision fatigue,decisional conflict,and shared decision-making among surrogate decision-makers of ICU patients,and to provide a reference for developing shared decision-making plans that better meet the needs of patients.Methods A total of 192 surrogate decision-makers of ICU patients were selected using a convenience sampling method and were invited to complete a general information questionnaire,the Decision Fatigue Scale,the Decisional Conflict Scale,and the Shared Decision Making Questionnaire(SDM-Q-9).Results The participants scored(22.15±6.17) for decision fatigue,(41.55±14.00) for decisional conflict,and(78.47±12.86) for shared decision-making.Decisional conflict was negatively correlated with shared decision-making(P<0.05).Monthly income,whether living with the patient,and APACHEⅡ score of the patient were the influencing factors of decision fatigue for surrogate decision makers,while APACHEⅡ score was the influencing factor of decisional conflict,and medical payment type was the influencing factor of shared decision-making(all P<0.05).Conclusion The levels of decision fatigue and decisional conflict are relatively high in surrogate decision makers of ICU patients,while the level of shared decision-making is medium.Medical staff should pay attention to the factors affecting decision fatigue and decisional conflict in surrogate decision makers,and encourage them to participate in shared decision-making,thus to ameliorate their decision fatigue and decisional conflict.

关 键 词：ICU 替代决策者 决策疲劳 决策冲突 共享决策 决策质量 APACHEⅡ评分 影响因素 

分 类 号：R473.1[医药卫生—护理学]