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Intensive care
Original research
Shared decision-making in the ICU from the perspective of physicians, nurses and patients: a qualitative interview study
  1. Nina Wubben,
  2. Mark van den Boogaard,
  3. JG van der Hoeven,
  4. Marieke Zegers
  1. Intensive care, Radboudumc, Nijmegen, Gelderland, The Netherlands
  1. Correspondence to Dr Marieke Zegers; marieke.zegers{at}radboudumc.nl

Abstract

Objective To identify views, experiences and needs for shared decision-making (SDM) in the intensive care unit (ICU) according to ICU physicians, ICU nurses and former ICU patients and their close family members.

Design Qualitative study.

Setting Two Dutch tertiary centres.

Participants 19 interviews were held with 29 participants: seven with ICU physicians from two tertiary centres, five with ICU nurses from one tertiary centre and nine with former ICU patients, of whom seven brought one or two of their close family members who had been involved in the ICU stay.

Results Three themes, encompassing a total of 16 categories, were identified pertaining to struggles of ICU physicians, needs of former ICU patients and their family members and the preferred role of ICU nurses. The main struggles ICU physicians encountered with SDM include uncertainty about long-term health outcomes, time constraints, feeling pressure because of having final responsibility and a fear of losing control. Former patients and family members mainly expressed aspects they missed, such as not feeling included in ICU treatment decisions and a lack of information about long-term outcomes and recovery. ICU nurses reported mainly opportunities to strengthen their role in incorporating non-medical information in the ICU decision-making process and as liaison between physicians and patients and family.

Conclusions Interviewed stakeholders reported struggles, needs and an elucidation of their current and preferred role in the SDM process in the ICU. This study signals an essential need for more long-term outcome information, a more informal inclusion of patients and their family members in decision-making processes and a more substantial role for ICU nurses to integrate patients’ values and needs in the decision-making process.

  • adult intensive & critical care
  • qualitative research
  • medical ethics

Data availability statement

Data are available upon reasonable request. The data used and/or analysed during the current study are available from the corresponding author on reasonable request.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2021-050134

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    Data availability statement

    Data are available upon reasonable request. The data used and/or analysed during the current study are available from the corresponding author on reasonable request.

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    Footnotes

    • Twitter @ICresearch_Rumc

    • Contributors NW, MvdB, JvdH and MZ contributed substantially to the conception of the work. Each author contributed substantially to the design of the work. NW, MvdB and MZ contributed substantially to the acquisition and analysis of the data. Each author contributed substantially to the interpretation of the data. NW drafted the manuscript. Each author contributed substantially to the revision of the work.Each author approved the submitted version. Each author agrees to be personally accountable for the author’s own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved and the resolution documented in the literature.

    • Funding This work was supported by Zorginstituut Nederland to last author MZ (2018026879).

    • Disclaimer Zorginstituut Nederland was not involved in the design of the study, nor with the data collection, analysis, interpretation or writing of the manuscript.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.