The value of uncertainty in critical illness? An ethnographic study of patterns and conflicts in care and decision-making trajectories

I. J. Higginson, C. Rumble, C. Shipman, J. Koffman, K. E. Sleeman, M. Morgan, P. Hopkins, J. Noble, W. Bernal, S. Leonard, O. Dampier, W. Prentice, R. Burman, M. Costantini

Research output: Contribution to journalArticlepeer-review

Abstract

Background: With increasingly intensive treatments and population ageing, more people face complex treatment and care decisions. We explored patterns of the decision-making processes during critical care, and sources of conflict and resolution. Methods: Ethnographic study in two Intensive Care Units (ICUs) in an inner city hospital comprising: non-participant observation of general care and decisions, followed by case studies where treatment limitation decisions, comfort care and/or end of life discussions were occurring. These involved: semi-structured interviews with consenting families, where possible, patients; direct observations of care; and review of medical records. Results: Initial non-participant observation included daytime, evenings, nights and weekends. The cases were 16 patients with varied diagnoses, aged 19-87 years; 19 family members were interviewed, aged 30-73 years. Cases were observed for

Original languageEnglish
Article number11
JournalBMC Anesthesiology
Volume16
Issue number1
DOIs
Publication statusPublished - Feb 9 2016

Keywords

  • Critical care
  • Decision-making
  • DNACPR
  • End-of-life care
  • Intensive care unit
  • Palliative care
  • Pathways
  • Uncertainty

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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