Shared decision-making in the ICU from the perspective of physicians, nurses and patients: a qualitative interview study

Wubben, Nina; Boogaard, Mark van den; Hoeven, Johannes G. van der; Zegers, Marieke

doi:10.1136/bmjopen-2021-050134

Cited by 22 publications

(39 citation statements)

References 65 publications

(57 reference statements)

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“…Although several factors affecting ICU SDM have been identified by researchers, such as patient/family willingness to participate in the decision-making process, staff expertise, and lack of time, in terms of previous studies, few researchers have explored barriers and facilitators from different SDM stakeholder groups in current ICU care [ 9 , 10 ]. In addition, due to the participation of family decision-making in ICUs in China, patients' values and treatment intention are less important.…”

Section: Introductionmentioning

confidence: 99%

The Perspectives of Surrogates and Healthcare Providers Regarding SDM (Shared Decision-Making)

et al. 2023

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The purpose of this paper is to explore the attitudes of surrogacy and medical service providers toward SDM and to identify the barriers and promoters of SDM in this population. To this end, we conducted a qualitative study of surrogacy and medical service providers in the First Affiliated Hospital of Soochow University using semistructured interviews. Thirty participants (11 agents, 12 ICU physicians, and 7 ICU nurses) were interviewed. The three stakeholders showed different attitudes toward SDM. They reported barriers to SDM, including insufficient cognition of decision-makers, high expectations, negative psychological experiences, previous decision-making experiences, excessive workload, heavy financial burden, and lack of decision AIDS. They reported facilitators of SDM, including trust, effective communication, decision support, value clarification, outcome commitment, and continuous service. This study explored the different attitudes of the three stakeholders and identified various barriers and facilitators of SDM. It highlights the need to develop localised decision AIDS and to involve agents and nurses more in the decision-making process. Therefore, this paper identifies barriers and facilitators of SDM in this population. In addition, the study identified various barriers and facilitators to SDM and highlighted the need to develop localised decision AIDS and involve agents and nurses more in the decision-making process. Finally, the barriers and facilitators of SDM are established. The paper also shows that the development of localized decision AIDS and greater involvement of agents and nurses in the decision-making process are integral to good treatment outcomes.

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Section: Introductionmentioning

confidence: 99%

The Perspectives of Surrogates and Healthcare Providers Regarding SDM (Shared Decision-Making)

et al. 2023

Disease Markers

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“…In addition to appropriate diagnosis and management of COPD [ 34 ], it is important to determine the possible outcomes of patients with COPD after hospitalization as early as possible so that prompt and effective treatment could be given to improve their prognosis. One of the most important tasks of a physician is to inform the patient and their loved ones about the seriousness of their condition [ 35 ]. The information may alter a patient’s view of their future and cause additional stress [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Machine Learning Approaches for Predicting Acute Respiratory Failure, Ventilator Dependence, and Mortality in Chronic Obstructive Pulmonary Disease

2021

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Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality and contributes to high morbidity worldwide. Patients with COPD have a higher risk for acute respiratory failure, ventilator dependence, and mortality after hospitalization compared with the general population. Accurate and early risk detection will provide more information for early management and better decision making. This study aimed to build prediction models using patients’ characteristics, laboratory data, and comorbidities for early detection of acute respiratory failure, ventilator dependence, and mortality in patients with COPD after hospitalization. We retrospectively collected the electronic medical records of 5061 patients with COPD in three hospitals of the Chi Mei Medical Group, Taiwan. After data cleaning, we built three prediction models for acute respiratory failure, ventilator dependence, and mortality using seven machine learning algorithms. Based on the AUC value, the best model for mortality was built by the XGBoost algorithm (AUC = 0.817), the best model for acute respiratory failure was built by random forest algorithm (AUC = 0.804), while the best model for ventilator dependence was built by LightGBM algorithm (AUC = 0.809). A web service application was implemented with the best models and integrated into the existing hospital information system for physician’s trials and evaluations. Our machine learning models exhibit excellent predictive quality and can therefore provide physicians with a useful decision-making reference for the adverse prognosis of COPD patients.

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“…23 Shared decision-making has been widely implemented in long-term and complex conditions where more than one treatment is available, and is increasingly being adapted across more complex clinical settings, for example, intensive care. 24 25 The assumption is that shared decision-making is operating as business as usual and supporting both professionals and patients to make more informed decisions, improving patient outcomes and experiences of care. It is also linked to longer-term plans to deliver universal personalised care.…”

Section: Introductionmentioning

confidence: 99%

Interventions for and experiences of shared decision-making underpinning reproductive health, family planning options and pregnancy for women with or at high risk of kidney disease: a systematic review and qualitative framework synthesis

2022

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ObjectiveTo determine intervention effects and synthesise qualitative research that explored women with or at high risk of kidney disease experiences of shared decision-making in relation to their reproductive health, family planning options and pregnancy.DesignA systematic review of interventions and a qualitative evidence synthesis.Data sourcesWe searched Cochrane, CINAHL, MEDLINE, Scopus, ProQuest, Elsevier, PubMed, ScienceDirect and Web of Science.Eligibility criteriaShared decision-making interventions and qualitative studies related to reproductive health involving women with or at high risk of kidney disease published from 1980 until January 2021 in English (clinical settings, global perspective).Data extraction and synthesisTitles were screened against the inclusion criteria and full-text articles were reviewed by the whole team. Framework synthesis was undertaken.ResultsWe screened 1898 studies. No evidence-based interventions were identified. 18 qualitative studies were included, 11 kidney disease-specific studies and 7 where kidney disease was a common comorbidity. Women frequently felt unprepared and uninformed about their reproductive options. Conversations with healthcare professionals were commonly described as frustrating and unhelpful, often due to a perceived loss of autonomy and a mismatch in preferences and life goals. Examples of shared decision-making were rare. Kidney disease exacerbated societal expectations of traditional gender roles (eg, wife, mother, carer) including capability to have children and associated factors, for example, parenting, (sexual) relationships, body image and independent living (including financial barriers to starting a family). Local interventions were limited to types of counselling. A new health system model was developed to support new interventions.ConclusionThere is a clear need to establish new interventions, test those already in development and develop new clinical guidance for the management of women with or at high risk of kidney disease in relation to their reproductive health, including options to preserve fertility earlier. Other health conditions with established personalised reproductive care packages, for example, cancer, could be used to benchmark kidney practice alongside the new model developed here.

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Shared decision-making in the ICU from the perspective of physicians, nurses and patients: a qualitative interview study

Cited by 22 publications

References 65 publications

The Perspectives of Surrogates and Healthcare Providers Regarding SDM (Shared Decision-Making)

The Perspectives of Surrogates and Healthcare Providers Regarding SDM (Shared Decision-Making)

Machine Learning Approaches for Predicting Acute Respiratory Failure, Ventilator Dependence, and Mortality in Chronic Obstructive Pulmonary Disease

Interventions for and experiences of shared decision-making underpinning reproductive health, family planning options and pregnancy for women with or at high risk of kidney disease: a systematic review and qualitative framework synthesis

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