Achieving Goals of Care Decisions in Chronic Critical Illness A Multi-Institutional Qualitative Study

被引：1

作者：

Andersen, Sarah K. ^{[1
,2
]}

Yang, Yanran ^{[3
,4
]}

Kross, Erin K. ^{[5
,6
]}

Haas, Barbara ^{[7
,8
]}

Geagea, Anna ^{[9
]}

May, Teresa L. ^{[10
]}

Hart, Joanna ^{[11
]}

Bagshaw, Sean M. ^{[2
]}

Dzeng, Elizabeth ^{[12
]}

Fischhoff, Baruch ^{[3
]}

White, Douglas B. ^{[1
]}

机构：

[1] Univ Pittsburgh, Clin Res Invest & Syst Modeling Acute Illness CRIS, Sch Med, Dept Crit Care Med,Program Eth & Decis Making, Pittsburgh, PA 15260 USA

[2] Univ Alberta, Fac Med & Dent, Dept Crit Care Med, Edmonton, AB, Canada

[3] Carnegie Mellon Univ, Dept Engn & Publ Policy, Pittsburgh, PA USA

[4] Duke Kunshan Univ, Global Hlth Res Ctr, Kunshan, Jiangsu, Peoples R China

[5] Univ Washington, Div Pulm Crit Care & Sleep Med, Seattle, WA USA

[6] Cambia Palliat Care Ctr Excellence UW Med, Seattle, WA USA

[7] Univ Toronto, Interdept Div Crit Care, Toronto, ON, Canada

[8] Univ Toronto, Dept Surg, Toronto, ON, Canada

[9] North York Gen Hosp, Dept Med, Div Crit Care Med, Toronto, ON, Canada

[10] Maine Med Ctr, Dept Pulm & Crit Care, Portland, ME USA

[11] Univ Penn, Palliat & Adv Illness Res Ctr, Dept Med, Philadelphia, PA USA

[12] Univ Calif San Francisco, Div Hosp Med, Dept Med, San Francisco, CA USA

来源：

CHEST | 2024年 / 166卷 / 01期

基金：

美国国家卫生研究院;

关键词：

chronic critical illness; communication; critical care; decision-making; goals of care; intensive care; MENTAL MODELS; COMMUNICATION; INTERVIEWS; CHALLENGES; FAMILIES; TEAMWORK; MEETINGS; IMPACT; LIFE; ICU;

D O I：

10.1016/j.chest.2024.02.015

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

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 fi ed barriers to GOC decision-making included 1-week staffing fi ng models, limited time and cognitive bandwidth, difficulty fi culty 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 and consistent communication are to GOC decision in CCI.

引用

页码：107 / 117

页数：11

共 47 条

[1] Shared Decision-Making Training for Home Care Teams to Engage Frail Older Adults and Caregivers in Housing Decisions: Stepped-Wedge Cluster Randomized Trial [J].