Framework to Support the Process of Decision-Making on Life-Sustaining Treatments in the ICU : Results of a Delphi Study
Kerckhoffs, Monika C. (University Medical Center Utrecht)
Senekal, Jannien (College of Intensive Care Medicine of Australia and New Zealand)
van Dijk, Diederik (University Medical Center Utrecht)
Artigas Raventós, Antoni (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Butler, Jenie (University of Queensland)
Michalsen, Andrej (Tettnang Hospital (Alemanya))
van Mol, Margo M. C. (Erasmus University Medical Center)
Moreno, Rui (Hospital de São José (Lisboa, Portugal))
Pais da Silva, Filipa (Hospital de São José (Lisboa, Portugal))
Picetti, Edoardo (University Hospital of Parma)
Póvoa, Pedro (Hospital de São Francisco Xavier (Lisboa, Portugal))
Robertsen, Annette (Oslo University Hospital (Oslo, Noruega))
van Delden, Johannes J. M. (University Medical Center Utrecht)

Date:	2020
Abstract:	Supplemental Digital Content is available in the text. A three-round web-based international Delphi consensus study with a priori consensus definition was conducted with experts from 13 countries. Participants reviewed items of the decision-making process on a seven-point Likert scale or with open-ended questions. Questions concerned terminology, content, and timing of decision-making steps. The summarized results (including mean scores) and expert suggestions were presented in the subsequent round for review. Web-based surveys of international participants representing ICU physicians, nurses, former ICU patients, and surrogate decision makers. Not applicable. Not applicable. In three rounds, respectively, 28, 28, and 27 (of 33 invited) physicians together with 12, 10, and seven (of 19 invited) nurses participated. Patients and surrogates were involved in round one and 12 of 27 responded. Caregivers were mostly working in university affiliated hospitals in Northern Europe. During the Delphi process, most items were modified in order to reach consensus. Seven items lacked consensus after three rounds. The final consensus framework comprises the content and timing of four elements; three elements focused on caregiver-surrogate communication (admission meeting, follow-up meeting, goals-of-care meeting); and one element (weekly time-out meeting) focused on assessing preferences, prognosis, and proportionality of ICU treatment among professionals. Physicians, nurses, patients, and surrogates generated a consensus-based framework to guide the process of decision-making on continuing or limiting life-sustaining treatments in the ICU. Early, frequent, and scheduled family meetings combined with a repeated multidisciplinary time-out meeting may support decisions in relation to patient preferences, prognosis, and proportionality.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Clinical decision-making ; Critical care ; Delphi technique ; Intensive care units ; Patient care planning
Published in:	Critical Care Medicine, Vol. 48 (april 2020) , p. 645-653, ISSN 1530-0293

DOI: 10.1097/CCM.0000000000004221
PMID: 32310619

9 p, 2.0 MB

The record appears in these collections:
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Parc Taulí Research and Innovation Institute (I3PT
Articles > Research articles
Articles > Published articles