A case for preference-sensitive decision timelines to aid shared decision-making in intensive care: need and possible...

Area of Science:

• Medical Ethics
• Clinical Decision-Making
• Health Informatics

Background:

• Intensive care units (ICUs) present challenges in aligning patient preferences with treatment due to patient incapacitation.
• Advance directives and surrogate input are vital for managing treatment decisions in ICUs.
• Shared decision-making requires awareness of preference-sensitive moments throughout treatment.

Purpose of the Study:

• To examine the necessity for preference-sensitive decision timelines.
• To propose a model timeline using aneurysmal subarachnoid hemorrhage as a use case.
• To illustrate the potential value and form of such timelines.

Main Methods:

• Literature review to identify needs for guidance in preference elicitation, advance directives, and surrogate preparation.
• Development of a model preference-sensitive decision timeline.
• Informed by existing guidelines and interviews with patients, surrogates, and neuro-ICU clinicians.

Main Results:

• Identified critical needs for clinician guidance on when to elicit patient preferences.
• Demonstrated the value of highlighting preference-sensitive instances for shared decision-making and advance care planning.
• Proposed a model timeline for aneurysmal subarachnoid hemorrhage, showcasing practical application.

Conclusions:

• Preference-sensitive decision timelines are essential for improving shared decision-making in ICUs.
• These timelines can aid clinicians, support advance care planning, and prepare surrogates.
• Integration into digital tools could further enhance their utility in clinical practice.