Decision-Making About Potentially Non-Beneficial Intensive Care Unit Treatments: Interviews of Family Members from an Academic Public Hospital

Abstract

Objective

Developing effective strategies to improve shared decision-making (SDM) about potentially non-beneficial intensive care unit (ICU) treatments for patients with advanced medical illness requires understanding patients’ and family members’ perspectives. This study explores family members’ experiences in discussing potentially non-beneficial treatments with ICU clinicians to identify factors that influenced their decision-making.

Methods

Semi-structured interviews of pre-dominantly non-White family members making decisions about potentially non-beneficial ICU treatments were conducted in the medical ICU of an academic public hospital in Los Angeles County. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis.

Results

Eighteen surrogate decision-makers were interviewed for this study. Perceived barriers to decision-making included intimidation, dehumanizing family meetings, time-pressure to make decisions, and uncertainty of benefit from ICU treatments. Factors that affected the perceived susceptibility from harm or likelihood of benefit from invasive treatments included health status prior to hospitalization, physicians’ discussion of prognoses, and direct observation of clinical status during ICU hospitalization. Greater self-efficacy in making decisions was promoted by stronger family support, gaining experience with the clinical situation, and empathic characteristics of the clinical team.

Conclusions

Interviews with family members at a single ICU revealed that strategies to improve decision-making may include emphasizing empathic communication styles that focus on patients’ values and preferences for care, reducing time-pressure and uncertainty by seeing the effects of ICU treatments, and creating time for families to adjust and seek social support. Adopting this approach may allow ICU clinicians and family members to become more aligned in their efforts to provide compassionate care for patients while minimizing non-beneficial treatments. These findings need to be validated in larger patient populations.

Keywords

end of life care ICU outcomes decision-making critical illness palliative care non-beneficial treatments

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