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

Frontiers in Digital Health

Digital Health

Andrea Ferrario¹  Sophie Gloeckler²  Beatrix Göcking²  Nikola Biller-Andorno²  Andrea Glässel³  Giovanna Brandi⁴ 

[1] Department of Management, Technology, and Economics, Swiss Federal Institute of Technology in Zurich, Zurich, Switzerland;Mobiliar Lab for Analytics at ETH, Zurich, Switzerland;Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland;Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland;School of Health Sciences, Institute of Public Health, Zurich University of Applied Sciences, Winterthur, Switzerland;Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland;

关键词: shared decision-making;    decision aids;    subarachnoid hemorrhage;    advance care planning;    surrogate decision-makers;    critical care;   

DOI  :  10.3389/fdgth.2023.1274717

 received in 2023-08-08, accepted in 2023-09-28,  发布年份 2023

来源: Frontiers

【 摘 要 】

In the intensive care unit, it can be challenging to determine which interventions align with the patients' preferences since patients are often incapacitated and other sources, such as advance directives and surrogate input, are integral. Managing treatment decisions in this context requires a process of shared decision-making and a keen awareness of the preference-sensitive instances over the course of treatment. The present paper examines the need for the development of preference-sensitive decision timelines, and, taking aneurysmal subarachnoid hemorrhage as a use case, proposes a model of one such timeline to illustrate their potential form and value. First, the paper draws on an overview of relevant literature to demonstrate the need for better guidance to (a) aid clinicians in determining when to elicit patient preference, (b) support the drafting of advance directives, and (c) prepare surrogates for their role representing the will of an incapacitated patient in clinical decision-making. This first section emphasizes that highlighting when patient (or surrogate) input is necessary can contribute valuably to shared decision-making, especially in the context of intensive care, and can support advance care planning. As an illustration, the paper offers a model preference-sensitive decision timeline—whose generation was informed by existing guidelines and a series of interviews with patients, surrogates, and neuro-intensive care clinicians—for a use case of aneurysmal subarachnoid hemorrhage. In the last section, the paper offers reflections on how such timelines could be integrated into digital tools to aid shared decision-making.

【 授权许可】

Unknown   
© 2023 Göcking, Gloeckler, Ferrario, Brandi, Glässel and Biller-Andorno.