The decision-making process of transferring patients home to die from an intensive care unit in mainland China: A qualitative study of family members’ experiences

Home is widely reported as the preferred place of death for patients and family members (Nilsson et al., 2017, Gomes et al., 2013, Murtagh et al., 2012). However, the practice of transferring patients home to die from an intensive care unit (ICU) to achieve this preference varies between different healthcare systems and social contexts (Lin et al., 2021). In countries such as the UK, North America, Europe, and Australia, transferring home from an ICU is a rare event driven by individual preferences and wishes (Coombs et al., 2015a, Lusardi et al., 2011, Coombs et al., 2017, Hutchinson and van Wissen, 2017, Campbell, 2013, Beuks et al., 2006). In countries such as China and Tunisia transferring patients home to die from an ICU is more common, motivated by cultural expectations, traditions and family members’ views and expectations (Sheng et al., 2012, Huang et al., 2009, Liu et al., 2016, Ouanes et al., 2012, Boussarsar and Bouchoucha, 2006). For example, only 9 % of patients in mainland China die in ICUs (He et al., 2020) whereas globally, approximately 20 % of patients die in the ICU after admission (Vincent et al., 2018, Bagshaw et al., 2018, Estenssoro et al., 2017, Sakr et al., 2018). Furthermore, 35 % – 60 % of patients in Chinese ICUs are reported as being moved home to die after life-sustaining treatments have been withdrawn (Zhao et al., 2014, Sheng et al., 2012, Xu et al., 2001).

The global literature suggests that the care needs of patients who are transferred home to die in countries such as China and Tunisia are different to those transferred home to die in countries such as UK, North America, Europe and Australia. For example, studies from China (Huang et al., 2009, Zhao et al., 2014) and Tunisia (Kallel et al., 2006) reported that patients transferred home to die from ICUs were often unconscious, intubated and ventilated and unstable. Elsewhere patients were more likely to be conscious, without intubation and ventilation and stable (Tellett and Davis, 2009, Beuks et al., 2006, Campbell, 2013, Crighton et al., 2008, Lusardi et al., 2011, Tellett et al., 2012, Coombs et al., 2015a, Darlington et al., 2015, Coombs et al., 2015b).

Despite the practice of transferring home to die from ICU being common in China, the research on this practice focuses on the prevalence of this practice (Xu et al., 2001, Sheng et al., 2012, Zhao et al., 2014, Xie et al., 2015, Liu et al., 2016, Liu and Zhu, 2016, Huang et al., 2009). A better understanding about how family members make decisions to transfer a patient home to die from ICU, with a focus on decision-making processes and available options (Zachary et al., 1982), will contribute to the body of international evidence in this area and potentially lead to practice development and change in this area of ICU practice. To develop evidence-based guidelines for this complex practice and encourage clinical actions, empirical research is needed in countries where it is more common, for example China. While home transfer is not an option for all, evidence suggests that patients and family members report a preference to die at home rather than hospitals or institutions (Nilsson et al., 2017, Gomes et al., 2013, Murtagh et al., 2012). The processes, decision-makers, underlying assumptions, and drivers for decisions may vary across societies but should be the first step in research where knowledge is limited, and from which further evidence can be generated to inform initiatives that support decision making about transferring the patient home to die.

留言 (0)

沒有登入
gif