Objective
To develop a list of non-emergent, potentially harmful interventions commonly performed in ICUs that require a clear understanding of patients’ treatment goals.
Background
A 2016 policy statement from the American Thoracic Society and American College of Critical Care Medicine calls on intensivists to engage in shared decision-making when “making major treatment decisions that may be affected by personal values, goals, and preferences.”
Methods
A three-round modified Delphi consensus process was conducted via a panel of 6 critical care physicians, 6 ICU nurses, 6 former ICU patients, and 6 family members from 6 academic and community-based medical institutions in the U.S. mid-Atlantic region.
Results
Recommendations about 8 interventions achieved consensus among respondents: 1) Permanent feeding tube (percutaneous feeding tube or “PEG” tube), 2) Permanent dialysis catheter, 3) Suprapubic urinary catheter, 4) Tracheotomy, 5) Long-term venous catheter, 6) Pulmonary artery catheter, 7) In-hospital dialysis, or 8) temporary NG feeding tube.
Conclusions
Clinical and patient/family participants in a modified Delphi consensus process were able to identify preference-sensitive decisions that should trigger clinicians to clarify patient goals and consider initiating shared decision making.