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Aligning critical care interventions with patient goals: A modified Delphi study.
Alison E Turnbull1, Sarina K Sahetya2, Dale M Needham3
1Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD, USA; Division of Pulmonary & Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Heart & Lung : the Journal of Critical Care
|September 6, 2016
Summary
A consensus process identified 8 potentially harmful ICU interventions requiring clear patient goals. This guides intensivists in shared decision-making for preference-sensitive care, improving patient-centered outcomes.
Area of Science:
- Critical care medicine
- Medical ethics
- Patient-centered care
Background:
- A 2016 policy statement emphasized shared decision-making in critical care.
- Intensivists are urged to consider patient values in major treatment decisions.
Purpose of the Study:
- To identify non-emergent, potentially harmful interventions in intensive care units (ICUs).
- To establish a list of interventions necessitating a clear understanding of patient treatment goals.
Main Methods:
- A modified Delphi consensus process was used.
- A diverse panel included critical care physicians, ICU nurses, former ICU patients, and family members.
- Participants represented multiple academic and community medical institutions.
Main Results:
- Consensus was reached on 8 specific interventions.
- These interventions were identified as potentially harmful and requiring goal clarification.
Conclusions:
- Clinical and patient/family participants successfully identified preference-sensitive decisions.
- These decisions should prompt clinicians to clarify patient goals and initiate shared decision-making.
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