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Research paper| Volume 33, ISSUE 5, P480-483, September 2020

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Shared decision-making in the intensive care unit requires more frequent and high-quality communication: A research critique

Published:February 19, 2020DOI:https://doi.org/10.1016/j.aucc.2019.12.001
Shared decision-making in the intensive care unit requires more frequent and high-quality communication: A research critique
Previous ArticleDelirium in intensive care: A stepped-wedge cluster randomised controlled trial for a nurse-led intervention to reduce the incidence and duration of delirium among adults admitted to the intensive care unit (protocol)
      Informing and actively involving patients and their families in decision-making is a goal of patient- and family-centred health care.
      • Cai X.
      • Robinson J.
      • Muehlschlegel S.
      • White D.B.
      • Holloway R.G.
      • Sheth K.N.
      • et al.
      Patient preferences and surrogate decision making in neuroscience intensive care units.
      Neurocritical Care. 2015; 23 (Epub 2015/05/21; PubMed PMID: 25990137; PubMed Central PMCID: PMCPmc4816524): 131-141https://doi.org/10.1007/s12028-015-0149-2
      Shared decision-making is a collaborative process that enables healthcare decisions to be made between patients and/or families and clinicians, with consideration of patient values and preferences, while also using the best available scientific evidence to make recommendations.
      • Kon A.A.
      • Davidson J.E.
      • Morrison W.
      • Danis M.
      • White D.B.
      Shared decision making in ICUs: an American College of critical care medicine and American thoracic society policy statement.
      Crit Care Med. 2016; 44 (Epub 2015/10/29; PubMed PMID: 26509317; PubMed Central PMCID: PMCPmc4788386): 188-201https://doi.org/10.1097/ccm.0000000000001396
      This collaborative process is recommended by critical care societies
      • Fried T.R.
      Communication about treatment options and shared decision making in the intensive care unit.
      JAMA Intern Med. 2019; 179: 684-685https://doi.org/10.1001/jamainternmed.2019.0034
      and healthcare organisations internationally.

      ACSQHC. Australian Commission on Safety and Quality in Health Care. Partnering with consumers standard (Action 2.5, 2.6, 2.7). Retrieved from: https://www.safetyandquality.gov.au/standards/nsqhs-standards/partnering-consumers-standard.2018.

      , 
      • Flannery L.
      • Ramjan L.M.
      • Peters K.
      End-of-life decisions in the Intensive Care Unit (ICU) – exploring the experiences of ICU nurses and doctors – a critical literature review.
      Aust Crit Care. 2016; 29: 97-103https://doi.org/10.1016/j.aucc.2015.07.004
      , 
      WHO. World Health Organistion
      Patient safety.
      https://www.who.int/patientsafety/en/
      Date: 2018
      Patients in intensive care units (ICUs) are often incapacitated and unable to communicate their treatment preferences. In these instances, the patients' families and friends assume the role of surrogate decision-makers (surrogates). Often, these surrogates find themselves in family meetings with clinicians where they are faced with challenging decisions made even more complex by the uncertainty of patient prognoses.
      • Cai X.
      • Robinson J.
      • Muehlschlegel S.
      • White D.B.
      • Holloway R.G.
      • Sheth K.N.
      • et al.
      Patient preferences and surrogate decision making in neuroscience intensive care units.
      Neurocritical Care. 2015; 23 (Epub 2015/05/21; PubMed PMID: 25990137; PubMed Central PMCID: PMCPmc4816524): 131-141https://doi.org/10.1007/s12028-015-0149-2
      Scheunemann et al.
      • Scheunemann L.P.
      • Ernecoff N.C.
      • Buddadhumaruk P.
      • Carson S.S.
      • Hough C.L.
      • Curtis J.R.
      • et al.
      Clinician-family communication about patients' values and preferences in intensive care units.
      JAMA Intern Med. 2019; 179 (PubMed PMID: 136383893. Language: English. Entry Date: In Process. Revision Date: 20190612. Publication Type: journal article. Journal Subset: Biomedical): 676-684https://doi.org/10.1001/jamainternmed.2019.0027
      recently explored this important area in a study of 249 family conferences, analysing how patient values and preferences are elicited during family meetings and how these preferences are applied to shared decisions made between surrogates and clinicians. A critique of this article is presented in the following.

      Keywords

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      Article info

      Publication history

      Published online: February 19, 2020
      Accepted: December 1, 2019
      Received: November 26, 2019

      Footnotes

      ☆Research article for critique: Scheunemann, L.P., Ernecoff, N.C., Buddadhumaruk, P., Carson, S.S., Hough, C.L., Curtis, J. R., White, D.B. (2019). Clinician-Family Communication About Patients' Values and Preferences in Intensive Care Units. JAMA Internal Medicine, 179(5), 676–684. https://doi.org/10.1001/jamainternmed.2019.0027

      Identification

      DOI: https://doi.org/10.1016/j.aucc.2019.12.001

      Copyright

      © 2019 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

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