Talking to multi-morbid patients about critical illness: an evolving conversation

Area of Science:

• Critical care medicine
• Patient outcomes research
• Quality of life studies

Background:

• Discussions on intensive care unit (ICU) survival are evolving beyond binary life/death outcomes.
• Focus is shifting towards recognizing survival with functional impairment versus late death.
• ICU admissions frequently lead to significant, long-lasting functional and cognitive disabilities.

Purpose of the Study:

• To explore the concept of response shift in critical illness.
• To analyze the implications for trade-offs between invasive treatments and patient-centered outcomes.
• To highlight the importance of patient priorities, such as independence, in decision-making.

Main Methods:

• Discussion of response shift in the context of critical care.
• Analysis of the relationship between health outcomes and quality of life (QoL).
• Consideration of research strategies, including qualitative data collection, for decision-making.

Main Results:

• Patients prioritize maintaining independence over mere survival.
• Quality of life (QoL) post-critical illness is a crucial factor in judging ICU support benefits.
• Standard conversations may not fully capture patients' views on acceptable QoL.

Conclusions:

• Clinical practice risks conflating health outcomes with QoL.
• Conversations must clarify how specific health outcomes impact patient-relevant QoL.
• Shared decision-making should incorporate a broader range of patient, family, and clinician considerations beyond mortality likelihood.