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Value choices and considerations when limiting intensive care treatment: a qualitative study
K Halvorsen1, R Førde, P Nortvedt
1Faculty of Nursing Education, Akershus University College, Lillestrøm, Norway. kristin.halvorsen@medisin.uio.no
Acta Anaesthesiologica Scandinavica
|November 27, 2008
Summary
Limiting intensive care treatment involves complex decisions influenced by clinician guilt and differing perspectives. Transparency and interdisciplinary collaboration are crucial for ensuring equitable patient care.
Area of Science:
- Medical Ethics
- Intensive Care Medicine
- Clinical Decision-Making
Background:
- Intensive care treatment limitations involve complex values and considerations.
- Understanding clinician decision-making in limiting care is essential.
Purpose of the Study:
- To explore the values and considerations influencing decisions to limit intensive care treatment.
- To understand the rationale behind clinicians' choices in treatment limitation.
Main Methods:
- Qualitative methodology employed.
- Participant observation and in-depth interviews conducted.
- Focus on eliciting clinicians' underlying rationale for limiting treatment.
Main Results:
- Over-treatment in intensive care is perceived as a dilemma due to uncertain decision-making bases.
- Physicians may prolong futile treatment due to guilt or responsibility concerns.
- Differences in patient assessment perspectives exist between admitting wards and intensive care units.
- Clinician personality, specialty, unit culture, and interdisciplinary cooperation impact decisions.
Conclusions:
- Under-communicated considerations risk jeopardizing equal treatment for intensive care patients.
- Developing strategies for transparent, interdisciplinary decision-making is vital.
- Making hidden values visible, disclosing power structures, and respecting diverse perspectives are necessary for equitable care.
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