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Achieving Goals of Care Decisions in Chronic Critical Illness: A Multi-Institutional Qualitative Study.
Andersen, Sarah K; Yang, Yanran; Kross, Erin K; Haas, Barbara; Geagea, Anna; May, Teresa L; Hart, Joanna; Bagshaw, Sean M; Dzeng, Elizabeth; Fischhoff, Baruch; White, Douglas B.
Afiliación
  • Andersen SK; Program on Ethics and Decision Making, The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Critical Care Medicine, Faculty of Medicine and Dentist
  • Yang Y; Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA; Global Health Research Center, Duke Kunshan University, Jiangsu, China.
  • Kross EK; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA; Cambia Palliative Care Center of Excellence at UW Medicine, Seattle, WA.
  • Haas B; Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada.
  • Geagea A; Division of Critical Care Medicine, Department of Medicine, North York General Hospital, Toronto, ON, Canada.
  • May TL; Department of Pulmonary and Critical Care, Maine Medical Center, Portland, ME.
  • Hart J; Palliative and Advanced Illness Research Center, Department of Medicine, University of Pennsylvania, Philadelphia, PA.
  • Bagshaw SM; Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, AB, Canada.
  • Dzeng E; Division of Hospital Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA.
  • Fischhoff B; Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA.
  • White DB; Program on Ethics and Decision Making, The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Chest ; 166(1): 107-117, 2024 Jul.
Article en En | MEDLINE | ID: mdl-38365177
ABSTRACT

BACKGROUND:

Physicians, patients, and families alike perceive a need to improve how goals of care (GOC) decisions occur in chronic critical illness (CCI), but little is currently known about this decision-making process. RESEARCH QUESTION How do intensivists from various health systems facilitate decision-making about GOC for patients with CCI? What are barriers to, and facilitators of, this decision-making process? STUDY DESIGN AND

METHODS:

We conducted semistructured interviews with a purposeful sample of intensivists from the United States and Canada using a mental models approach adapted from decision science. We analyzed transcripts inductively using qualitative description.

RESULTS:

We interviewed 29 intensivists from six institutions. Participants across all sites described GOC decision-making in CCI as a complex, longitudinal, and iterative process that involved substantial preparatory work, numerous stakeholders, and multiple family meetings. Intensivists required considerable time to collect information on prior events and conversations, and to arrive at a prognostic consensus with other involved physicians prior to meeting with families. Many intensivists stressed the importance of scheduling multiple family meetings to build trust and relationships prior to explicitly discussing GOC. Physician-identified barriers to GOC decision-making included 1-week staffing models, limited time and cognitive bandwidth, difficulty eliciting patient values, and interpersonal challenges with care team members or families. Potential facilitators included scheduled family meetings at regular intervals, greater interprofessional involvement in decisions, and consistent messaging from care team members.

INTERPRETATION:

Intensivists described a complex time- and labor-intensive group process to achieve GOC decision-making in CCI. System-level interventions that improve how information is shared between physicians and decrease logistical and relational barriers to timely and consistent communication are key to improving GOC decision-making in CCI.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Planificación de Atención al Paciente / Enfermedad Crítica / Investigación Cualitativa Límite: Adult / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Chest Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Planificación de Atención al Paciente / Enfermedad Crítica / Investigación Cualitativa Límite: Adult / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: Chest Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos