ICU危重症患者肾脏替代治疗家属代理决策辅助工具：以用户为中心的快速原型的研制

郑苗; 张永辉; 曹英; 尹昌林; 王丽华

doi:10.24920/004326

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ICU危重症患者肾脏替代治疗家属代理决策辅助工具：以用户为中心的快速原型的研制

中国医学科学杂志（英文） 2024年39卷第2期页码：91-101

论著 | Updated：2025-03-07

- ICU危重症患者肾脏替代治疗家属代理决策辅助工具：以用户为中心的快速原型的研制
  Enhanced Publication
- Affiliations：
  
  1.Department of Outpatient, First Affiliated Hospital of Army Medical University, Chongqing 400038, China
  2.Department of Critical Care Medicine, First Affiliated Hospital of Army Medical University, Chongqing 400038, China
  3.Administration Office; First Affiliated Hospital of Army Medical University, Chongqing 400038, China
- Author bio：
  
  E-mail: wanglihua@tmmu.edu.cn
- Funds：
- DOI：10.24920/004326
  中图分类号：
- 收稿日期：2023-12-02，
  
  录用日期：2024-03-19，
  
  网络出版日期：2024-05-20，
  
  纸质出版日期：2024-06-30
- Accepted：
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郑苗,张永辉,曹英等.ICU危重症患者肾脏替代治疗家属代理决策辅助工具：以用户为中心的快速原型的研制[J].中国医学科学杂志（英文）,2024,39(02):91-101.

Zheng Miao,Zhang Yong-Hui,Cao Ying,et al.Development of a Decision Aid for Family Surrogate Decision Makers of Critically Ill Patients Requiring Renal Replacement Therapy in ICU: A User-Centered Design for Rapid Prototyping[J].Chinese Medical Sciences Journal,2024,39(02):91-101.
郑苗,张永辉,曹英等.ICU危重症患者肾脏替代治疗家属代理决策辅助工具：以用户为中心的快速原型的研制[J].中国医学科学杂志（英文）,2024,39(02):91-101. DOI： 10.24920/004326.

Zheng Miao,Zhang Yong-Hui,Cao Ying,et al.Development of a Decision Aid for Family Surrogate Decision Makers of Critically Ill Patients Requiring Renal Replacement Therapy in ICU: A User-Centered Design for Rapid Prototyping[J].Chinese Medical Sciences Journal,2024,39(02):91-101. DOI： 10.24920/004326.

摘要

目的

肾脏替代治疗（renal replacement therapy

RRT）在危重症患者并发急性肾损伤的应用日益增加，但治疗的最佳时机尚不明确，患者预后的不确定性问题突出，造成医疗决策情境复杂、患者治疗伦理冲突和决策困境等现状。本研究旨在为危重症患者的家属替代决策者开发一种决策辅助工具（decision aid

DA），以支持家属参与ICU医患共同决策。

方法

基于以用户为中心设计的系统化流程来开发这项决策辅助工具。步骤包括：（i）竞争性分析：对当前应用市场和学术领域中与主题相关的现存DA进行检索，并对所获取的资源进行全面的分析评估，以探索DA的研制策略、开发技术、功能需求等要素；（ii）用户需求评估：采用半结构性访谈，探索家属替代决策者的决策经验，挖掘目标用户未被满足的决策需求，进而明确其核心需求；（iii）证据综合：基于循证医学研究方法，将最新临床证据和决策信息整合形成DA的主要内容。

结果

我们检索纳入了16个现存的与主题相关的DA进行竞争性分析，从中获取用于开发DA工具的重要见解。研究中对15名替代决策者的决策经历进行访谈，揭示了家属存在决策困境、决策的不确定感、决策能力不足和决策延迟等四个主题的决策需求。共纳入27篇文献用于证据综合。从来源于决策支持系统或临床指南的文献中提取关于疾病和治疗的基础知识作为DA决策工具的背景信息；从文献中筛选提炼出21项证据条目，呈现在RRT决策工具的益处和风险、可能的结果以及选择理由等板块的内容架构。我们将DA开发为基于Web版本的原型，引导用户通过识别治疗选项、权衡治疗利弊、澄清个人价值观与偏好、制定医患共同决策的实施计划这四个序贯性步骤来完成决策应用。

结论

本研究设计开发了一个用于ICU危重症患者肾脏替代治疗家属代理决策辅助工具的快速原型。未来将进一步评估该工具在临床决策场景中的可用性、可行性和干预效果。

Abstract

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.

关键词

Keywords

references

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