Dataset Information

Framework to Support the Process of Decision-Making on Life-Sustaining Treatments in the ICU: Results of a Delphi Study.

ABSTRACT:

Objectives

To develop a consensus framework that can guide the process of decision-making on continuing or limiting life-sustaining treatments in ICU patients, using evidence-based items, supported by caregivers, patients, and surrogate decision makers from multiple countries.

Design

A three-round web-based international Delphi consensus study with a priori consensus definition was conducted with experts from 13 countries. Participants reviewed items of the decision-making process on a seven-point Likert scale or with open-ended questions. Questions concerned terminology, content, and timing of decision-making steps. The summarized results (including mean scores) and expert suggestions were presented in the subsequent round for review.

Setting

Web-based surveys of international participants representing ICU physicians, nurses, former ICU patients, and surrogate decision makers.

Patients

Not applicable.

Interventions

Not applicable.

Measurements and main results

In three rounds, respectively, 28, 28, and 27 (of 33 invited) physicians together with 12, 10, and seven (of 19 invited) nurses participated. Patients and surrogates were involved in round one and 12 of 27 responded. Caregivers were mostly working in university affiliated hospitals in Northern Europe. During the Delphi process, most items were modified in order to reach consensus. Seven items lacked consensus after three rounds. The final consensus framework comprises the content and timing of four elements; three elements focused on caregiver-surrogate communication (admission meeting, follow-up meeting, goals-of-care meeting); and one element (weekly time-out meeting) focused on assessing preferences, prognosis, and proportionality of ICU treatment among professionals.

Conclusions

Physicians, nurses, patients, and surrogates generated a consensus-based framework to guide the process of decision-making on continuing or limiting life-sustaining treatments in the ICU. Early, frequent, and scheduled family meetings combined with a repeated multidisciplinary time-out meeting may support decisions in relation to patient preferences, prognosis, and proportionality.

SUBMITTER: Kerckhoffs MC

PROVIDER: S-EPMC7161724 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Publications

Framework to Support the Process of Decision-Making on Life-Sustaining Treatments in the ICU: Results of a Delphi Study.

Kerckhoffs Monika C MC Senekal Jannien J van Dijk Diederik D Artigas Antonio A Butler Jenie J Michalsen Andrej A van Mol Margo M C MMC Moreno Rui R Pais da Silva Filipa F Picetti Edoardo E Póvoa Pedro P Robertsen Annette A van Delden Johannes J M JJM

Critical care medicine 20200501 5

<h4>Objectives</h4>To develop a consensus framework that can guide the process of decision-making on continuing or limiting life-sustaining treatments in ICU patients, using evidence-based items, supported by caregivers, patients, and surrogate decision makers from multiple countries.<h4>Design</h4>A three-round web-based international Delphi consensus study with a priori consensus definition was conducted with experts from 13 countries. Participants reviewed items of the decision-making process ...[more]

PMID: 32310619

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Dataset Information

Framework to Support the Process of Decision-Making on Life-Sustaining Treatments in the ICU: Results of a Delphi Study.

Objectives

Design

Setting

Patients

Interventions

Measurements and main results

Conclusions

Publications

Framework to Support the Process of Decision-Making on Life-Sustaining Treatments in the ICU: Results of a Delphi Study.

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