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Heart Lung. 2016 Nov - Dec;45(6):517-524. doi: 10.1016/j.hrtlng.2016.07.011. Epub 2016 Sep 1.

Aligning critical care interventions with patient goals: A modified Delphi study.

Author information

1
Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD, USA; Division of Pulmonary & Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA. Electronic address: turnbull@jhmi.edu.
2
Division of Pulmonary & Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
3
Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD, USA; Division of Pulmonary & Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.

Abstract

OBJECTIVE:

To develop a list of non-emergent, potentially harmful interventions commonly performed in ICUs that require a clear understanding of patients' treatment goals.

BACKGROUND:

A 2016 policy statement from the American Thoracic Society and American College of Critical Care Medicine calls on intensivists to engage in shared decision-making when "making major treatment decisions that may be affected by personal values, goals, and preferences."

METHODS:

A three-round modified Delphi consensus process was conducted via a panel of 6 critical care physicians, 6 ICU nurses, 6 former ICU patients, and 6 family members from 6 academic and community-based medical institutions in the U.S. mid-Atlantic region.

RESULTS:

Recommendations about 8 interventions achieved consensus among respondents.

CONCLUSIONS:

Clinical and patient/family participants in a modified Delphi consensus process were able to identify preference-sensitive decisions that should trigger clinicians to clarify patient goals and consider initiating shared decision-making.

KEYWORDS:

Clinical decision-making; Critical care; Decision-making; Delphi technique; Life-sustaining treatments

PMID:
27593494
PMCID:
PMC5887162
DOI:
10.1016/j.hrtlng.2016.07.011
[Indexed for MEDLINE]
Free PMC Article

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