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Values, preferences and goals identified during shared decision making between critically ill patients and their
Sharyn L Milnes1,2,3, Yianni Mantzaridis1, Nicholas B Simpson1,3
1University Hospital Geelong, Barwon Health, Geelong, Australia.
Summary
Doctors identified key patient values, preferences, and goals during goals-of-care discussions for critically ill patients with life-limiting illnesses. Key themes included relationships, autonomy, quality of life, and physical comfort.
Area of Science:
- Medical Ethics
- Palliative Care
- Intensive Care Medicine
Background:
- Goals-of-care (GOC) discussions are crucial for critically ill patients with life-limiting illnesses.
- Understanding patient values, preferences, and goals is essential for effective shared decision-making.
- The iValidate program aimed to enhance shared decision-making skills among intensive care unit (ICU) registrars.
Purpose of the Study:
- To examine the values, preferences, and goals elicited from critically ill patients with life-limiting illnesses during GOC discussions.
- To identify key themes emerging from these discussions to inform clinical practice.
- To evaluate the impact of a shared decision-making program on eliciting patient-centered information.
Main Methods:
- A descriptive qualitative study was conducted using a four-stage latent content analysis.
- 354 GOC forms from 218 adult patients admitted to a tertiary ICU with life-limiting illnesses were analyzed.
- Data were categorized into themes and subthemes representing patient values, preferences, and goals.
Main Results:
- Four major themes emerged: connectedness and relational autonomy, autonomy of the decision-maker, balancing quality and quantity of life, and physical comfort.
- Subthemes included relationships, sense of place, enjoyment of activities, independence, dignity, cognitive function, quality of life, longevity, and physical comfort.
- Statements related to relationships, place, independence, and physical comfort were most frequently identified; longevity was least frequent.
Conclusions:
- Analysis of GOC discussions revealed a framework of patient values, preferences, and goals.
- This framework can assist clinicians in engaging in shared decision-making with critically ill patients.
- Shared decision-making training and support programs are vital for effective communication in end-of-life care within the ICU setting.
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