Shared decision-making in the ICU from the perspective of physicians, nurses and patients: a qualitative interview study

Abstract

ObjectiveTo identify views, experiences and needs for shared decision-making (SDM) in the intensive care unit (ICU) according to ICU physicians, ICU nurses and former ICU patients and their close family members.DesignQualitative study.SettingTwo Dutch tertiary centres.Participants19 interviews were held with 29 participants: seven with ICU physicians from two tertiary centres, five with ICU nurses from one tertiary centre and nine with former ICU patients, of whom seven brought one or two of their close family members who had been involved in the ICU stay.ResultsThree themes, encompassing a total of 16 categories, were identified pertaining to struggles of ICU physicians, needs of former ICU patients and their family members and the preferred role of ICU nurses. The main struggles ICU physicians encountered with SDM include uncertainty about long-term health outcomes, time constraints, feeling pressure because of having final responsibility and a fear of losing control. Former patients and family members mainly expressed aspects they missed, such as not feeling included in ICU treatment decisions and a lack of information about long-term outcomes and recovery. ICU nurses reported mainly opportunities to strengthen their role in incorporating non-medical information in the ICU decision-making process and as liaison between physicians and patients and family.ConclusionsInterviewed stakeholders reported struggles, needs and an elucidation of their current and preferred role in the SDM process in the ICU. This study signals an essential need for more long-term outcome information, a more informal inclusion of patients and their family members in decision-making processes and a more substantial role for ICU nurses to integrate patients’ values and needs in the decision-making process.

The Perspectives of Surrogates and Healthcare Providers Regarding SDM (Shared Decision-Making)

“…Although several factors affecting ICU SDM have been identified by researchers, such as patient/family willingness to participate in the decision-making process, staff expertise, and lack of time, in terms of previous studies, few researchers have explored barriers and facilitators from different SDM stakeholder groups in current ICU care [ 9 , 10 ]. In addition, due to the participation of family decision-making in ICUs in China, patients' values and treatment intention are less important.…”

Machine Learning Approaches for Predicting Acute Respiratory Failure, Ventilator Dependence, and Mortality in Chronic Obstructive Pulmonary Disease

“…In addition to appropriate diagnosis and management of COPD [ 34 ], it is important to determine the possible outcomes of patients with COPD after hospitalization as early as possible so that prompt and effective treatment could be given to improve their prognosis. One of the most important tasks of a physician is to inform the patient and their loved ones about the seriousness of their condition [ 35 ]. The information may alter a patient’s view of their future and cause additional stress [ 36 ].…”

Interventions for and experiences of shared decision-making underpinning reproductive health, family planning options and pregnancy for women with or at high risk of kidney disease: a systematic review and qualitative framework synthesis

“…23 Shared decision-making has been widely implemented in long-term and complex conditions where more than one treatment is available, and is increasingly being adapted across more complex clinical settings, for example, intensive care. 24 25 The assumption is that shared decision-making is operating as business as usual and supporting both professionals and patients to make more informed decisions, improving patient outcomes and experiences of care. It is also linked to longer-term plans to deliver universal personalised care.…”