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Shared Decision-Making for Patients with Stroke in Neurocritical Care: A Qualitative Meta-Synthesis
Hui Zhang1,2, Carmel Davies3,4, Diarmuid Stokes3
1Nursing Department, Jining No.1 People's Hospital, Health Road No.6, Rencheng District, Jining, 272000, China. hui.zhang2@ucdconnect.IE.
Neurocritical Care
|August 27, 2024
Summary
Shared decision-making (SDM) in neurocritical stroke care is complex due to prognostic uncertainty and varied stakeholder roles. Understanding these dynamics is crucial for aligning treatment decisions with patient values and improving care.
Area of Science:
- Neuroscience
- Medical Ethics
- Health Services Research
Background:
- Decision-making for stroke patients in neurocritical care presents unique challenges due to the severity of illness and patient-specific preferences.
- Shared decision-making (SDM) is recommended to align care with patient values, but evidence on stakeholder experiences in this context is limited.
Purpose of the Study:
- To conduct a comprehensive analysis of stakeholder experiences and perspectives in shared decision-making (SDM) for neurocritical stroke patients.
- To inform best practices for SDM in neurocritical care settings.
Main Methods:
- A qualitative meta-synthesis was performed following Joanna Briggs Institute (JBI) guidelines, using thematic synthesis.
- Searches included major databases (PubMed, CINAHL, EMBASE, PsycINFO, Web of Science) from inception to July 2023, with manual searches.
- Eighteen studies from five countries (2010-2023) were included after quality appraisal, with data analyzed using NVivo 12 software.
Main Results:
- Four analytical themes emerged: prognostic uncertainty, multifaceted balancing act, tripartite role dynamics and information exchange, and influences of sociocultural context.
- These themes provide insights into the essential elements, relationships, and behaviors characterizing SDM in neurocritical care.
- Life-sustaining treatment decisions were the most common focus within the included studies.
Conclusions:
- The meta-synthesis offers a conceptual understanding of SDM in neurocritical care, highlighting the need for stroke-specific communication strategies due to complex role dynamics.
- Further research is needed to expand the evidence base across diverse sociocultural settings to enhance understanding of SDM for neurocritical stroke patients.
