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 journalArticle

14 Citations (Scopus)

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

Fingerprint

Critical Illness
Uncertainty
Decision Making
Observation
Urban Hospitals
Negotiating
Critical Care
Medical Records
Intensive Care Units
Therapeutics
Interviews
Population
Conflict (Psychology)

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

Cite this

The value of uncertainty in critical illness? An ethnographic study of patterns and conflicts in care and decision-making trajectories. / Higginson, I. J.; Rumble, C.; Shipman, C.; Koffman, J.; Sleeman, K. E.; Morgan, M.; Hopkins, P.; Noble, J.; Bernal, W.; Leonard, S.; Dampier, O.; Prentice, W.; Burman, R.; Costantini, M.

In: BMC Anesthesiology, Vol. 16, No. 1, 11, 09.02.2016.

Research output: Contribution to journalArticle

Higginson, IJ, Rumble, C, Shipman, C, Koffman, J, Sleeman, KE, Morgan, M, Hopkins, P, Noble, J, Bernal, W, Leonard, S, Dampier, O, Prentice, W, Burman, R & Costantini, M 2016, 'The value of uncertainty in critical illness? An ethnographic study of patterns and conflicts in care and decision-making trajectories', BMC Anesthesiology, vol. 16, no. 1, 11. https://doi.org/10.1186/s12871-016-0177-2
Higginson, I. J. ; Rumble, C. ; Shipman, C. ; Koffman, J. ; Sleeman, K. E. ; Morgan, M. ; Hopkins, P. ; Noble, J. ; Bernal, W. ; Leonard, S. ; Dampier, O. ; Prentice, W. ; Burman, R. ; Costantini, M. / The value of uncertainty in critical illness? An ethnographic study of patterns and conflicts in care and decision-making trajectories. In: BMC Anesthesiology. 2016 ; Vol. 16, No. 1.
@article{741d6c6fac19489798060332d1a10437,
title = "The value of uncertainty in critical illness? An ethnographic study of patterns and conflicts in care and decision-making trajectories",
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",
keywords = "Critical care, Decision-making, DNACPR, End-of-life care, Intensive care unit, Palliative care, Pathways, Uncertainty",
author = "Higginson, {I. J.} and C. Rumble and C. Shipman and J. Koffman and Sleeman, {K. E.} and M. Morgan and P. Hopkins and J. Noble and W. Bernal and S. Leonard and O. Dampier and W. Prentice and R. Burman and M. Costantini",
year = "2016",
month = "2",
day = "9",
doi = "10.1186/s12871-016-0177-2",
language = "English",
volume = "16",
journal = "BMC Anesthesiology",
issn = "1471-2253",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - The value of uncertainty in critical illness? An ethnographic study of patterns and conflicts in care and decision-making trajectories

AU - Higginson, I. J.

AU - Rumble, C.

AU - Shipman, C.

AU - Koffman, J.

AU - Sleeman, K. E.

AU - Morgan, M.

AU - Hopkins, P.

AU - Noble, J.

AU - Bernal, W.

AU - Leonard, S.

AU - Dampier, O.

AU - Prentice, W.

AU - Burman, R.

AU - Costantini, M.

PY - 2016/2/9

Y1 - 2016/2/9

N2 - 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

AB - 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

KW - Critical care

KW - Decision-making

KW - DNACPR

KW - End-of-life care

KW - Intensive care unit

KW - Palliative care

KW - Pathways

KW - Uncertainty

UR - http://www.scopus.com/inward/record.url?scp=84960130150&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84960130150&partnerID=8YFLogxK

U2 - 10.1186/s12871-016-0177-2

DO - 10.1186/s12871-016-0177-2

M3 - Article

AN - SCOPUS:84960130150

VL - 16

JO - BMC Anesthesiology

JF - BMC Anesthesiology

SN - 1471-2253

IS - 1

M1 - 11

ER -