Exploring physician approaches to conflict resolution in end-of-life decisions in the adult intensive care unit: protocol for a systematic review of qualitative research

Abstract

IntroductionConflict is unfortunately well-documented in the adult intensive care unit (AICU). In the context of end-of-life (EOL) decision-making (ie, the withdrawal or withholding of life-sustaining treatment), conflict commonly occurs when a consensus cannot be reached between the healthcare team and the patient’s family on the ‘best interests’ of the critically ill, incapacitated patient. While existing literature has identified potential methods for conflict resolution, it is less clear how these approaches are perceived and used by stakeholders in the EOL decision-making process. We aim to explore this by systematically reviewing and synthesising the published evidence, which addresses the following research question: what does existing qualitative research reveal about physician approaches to addressing conflict arising in EOL decisions in the AICU?Methods and analysisPeer-reviewed qualitative studies (retrieved from MEDLINE, Project Muse, Scopus, EMBASE, Web of Science, PsycINFO, CINAHL, and LILACS) examining conflict and dispute resolution in the context of EOL decisions in the AICU setting will be included. Two reviewers will independently screen either all or a randomly selected sample of studies, with a third reviewer independently screening studies of uncertain eligibility. The ‘thematic synthesis’ approach will be employed to analyse the resulting data. The quality of included papers will be assessed using the 2018 Mixed-Methods Assessment Tool. The ‘Grading of Recommendations, Assessment, Development, and Evaluations-Confidence in the Evidence from Reviews of Qualitative research’ approach will be used to assess our confidence in the findings.Ethics and disseminationEthical approval is not required for this review, as only published data will be included. We anticipate that the findings will be of interest to healthcare professionals working in AICUs and individuals working in bioethics, given the ethically contentious nature of EOL decisions. The findings will be disseminated at academic conferences and through open-access publication in a peer-reviewed journal.PROSPERO registration numberCRD42021193769.

Efficacy of Advance Care Planning Support by Decision Aid in Intensive Care Patients: A Pilot Randomized Trial

“…Differences in the perceptions of treatment understanding among medical providers, patients, and family members lead to problems after treatment [31]. SDM in the ICU and Perioperative patients is very important [32][33][34], and it is essential to review wishes for life-sustaining treatment with the patient and family whenever the patient's situation changes to avoid misunderstandings and provide medical care that meets the patient's needs. PtDAs are effective for patients with SDM [35].…”