Values, preferences and goals identified during shared decision making between critically ill patients and their doctors

Objective: Examine values, preferences and goals elicited by doctors following goals-of-care (GOC) discussions with critically ill patients who had life-limiting illnesses. Design: Descriptive qualitative study using four-stage latent content analysis. Setting: Tertiary intensive care unit (ICU) in...

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Published in:Critical care and resuscitation Vol. 23; no. 1; pp. 76 - 85
Main Authors: Milnes, Sharyn L., Mantzaridis, Yianni, Simpson, Nicholas B., Dunning, Trisha L., Kerr, Debra C., Ostaszkiewicz, Joan B., Keely, Gerry T., Corke, Charlie, Orford, Neil R.
Format: Journal Article
Language:English
Published: Elsevier 01-03-2021
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Summary:Objective: Examine values, preferences and goals elicited by doctors following goals-of-care (GOC) discussions with critically ill patients who had life-limiting illnesses. Design: Descriptive qualitative study using four-stage latent content analysis. Setting: Tertiary intensive care unit (ICU) in South Western Victoria. Participants: Adults who had life-limiting illnesses and were admitted to the ICU with documented GOC, between October 2016 and July 2018. Intervention: The iValidate program, a shared decisionmaking clinical communication education and clinical support program, for all ICU registrars in August 2015. Main outcome measures: Matrix of themes and subthemes categorised into values, preferences and goals. Results: A total of 354 GOC forms were analysed from 218 patients who had life-limiting illnesses and were admitted to the ICU. In the categories of values, preferences and goals, four themes were identified: connectedness and relational autonomy, autonomy of decision maker, balancing quality and quantity of life, and physical comfort. The subthemes - relationships, sense of place, enjoyment of activities, independence, dignity, cognitive function, quality of life, longevity and physical comfort - provided a matrix of issues identified as important to patients. Relationship, place, independence and physical comfort statements were most frequently identified; longevity was least frequently identified. Conclusion: Our analysis of GOC discussions between medical staff and patients who had life-limiting illnesses and were admitted to the ICU, using a shared decision-making training and support program, revealed a framework of values, preferences and goals that could provide a structure to assist clinicians to engage in shared decision making.
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Critical Care and Resuscitation, Vol. 23, No. 1, Mar 2021: 76-85
ObjectType-Article-1
SourceType-Scholarly Journals-1
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content type line 23
ISSN:1441-2772
2652-9335
DOI:10.51893/2021.1.oa7