Tracheostomy Decision-making Communication among Patients Receiving Prolonged Mechanical Ventilation

Area of Science:

• Critical Care Medicine
• Respiratory Medicine
• Medical Communication

Background:

• Prolonged mechanical ventilation (PMV) is associated with high morbidity, mortality, and reduced quality of life.
• The decision-making process regarding tracheostomy for PMV patients lacks clarity in communication themes.
• Effective communication is vital for patient-centered care in intensive settings.

Purpose of the Study:

• To identify key communication themes in tracheostomy decision-making for patients on prolonged mechanical ventilation.
• To explore patient and clinical factors influencing the depth of these discussions.
• To enhance shared decision-making in critical care settings.

Main Methods:

• Mixed-methods study analyzing documented family meeting conversations for adult ICU patients on mechanical ventilation for ≥7 days.
• Consensus-driven review to identify tracheostomy decision-making themes.
• Multivariate analysis to correlate patient/clinical factors with discussion themes.

Main Results:

• 191/241 (79.2%) patients had documented tracheostomy discussions; 148 (61.4%) needed further talks.
• Identified themes: patient preferences, baseline condition, long-term complications, and prognosis.
• 45.3% of discussions lacked these themes; patients not receiving tracheostomy had more theme discussions (74.6% vs. 41.6%).

Conclusions:

• Information exchange on patient values and prognosis during tracheostomy decisions is insufficient, especially for those undergoing the procedure.
• There's a critical need for enhanced shared decision-making to align tracheostomy interventions with patient values.
• Improving communication can prevent unwanted health states and improve end-of-life care.