Identifying Decisional Needs for Adult Tracheostomy and Prolonged Mechanical Ventilation Decision Making to Inform...

Area of Science:

• Critical Care Medicine
• Medical Decision Making
• Bioethics

Background:

• Decision-making for adult tracheostomy and prolonged mechanical ventilation is complex and emotionally charged.
• Physician and surrogate expectations often misalign, hindering goal-concordant care.
• There is limited understanding of surrogate and provider decisional needs in this context.

Purpose of the Study:

• To explore the decision-making process for adult tracheostomy and prolonged mechanical ventilation.
• To identify the core decisional needs of surrogates and physicians.
• To inform the development of shared decision-making tools.

Main Methods:

• A qualitative study using semistructured interviews with 23 surrogates and 20 physicians.
• Thematic analysis was employed to identify key themes and decisional needs.
• Recruitment continued until thematic saturation was achieved.

Main Results:

• Three interconnected themes emerged: Hope, Lack of Knowledge & Data, and Uncertainty.
• Core decisional needs included information on patient wishes, history, outcomes, and meaningful recovery.
• Decision-making was influenced by a balance between surrogate emotions, understanding, and physician recommendations.

Conclusions:

• Tracheostomy and prolonged mechanical ventilation decisions are complex, influenced by hope, uncertainty, and data gaps.
• Understanding these themes and decisional needs can improve information delivery and align expectations.
• This research provides a framework for developing interventions to enhance shared decision-making.