Decision Aids in the ICU: a scoping review

Area of Science:

• Critical Care Medicine
• Health Decision Science
• Patient Engagement

Background:

• Decision aids are tools designed to support patients and families in making informed healthcare choices.
• Critically ill patients in the intensive care unit (ICU) face complex treatment decisions, often with significant implications.

Purpose of the Study:

• To synthesize the effectiveness and acceptability of decision aids for critically ill patients and their families in the ICU.
• To identify gaps and areas for improvement in the development and application of ICU decision aids.

Main Methods:

• A scoping review methodology guided by Arksey and O'Malley was employed.
• Systematic searches of four electronic databases and grey literature were conducted up to March 2023.
• Fourteen papers, detailing nine distinct decision aids, were included in the review.

Main Results:

• Most studies (92%) were North American, focusing on goals of care and life-sustaining treatments.
• Commonly measured outcomes included patient knowledge and code status, with some promising findings not replicated in randomized trials.
• The majority of included studies focused on the iterative development and testing of individual decision aids.

Conclusions:

• Current decision aids are insufficient for the complexity of ICU treatment decisions.
• There is a significant need for culturally tailored decision aids to broaden their applicability.
• Improved quality control for randomized controlled trials and clearer effectiveness indicators for decision aids are essential.