Inclusion and exclusion criteria
| Inclusion criteria | Exclusion criteria | |
| Context | Critical/intensive care settings where EOL decisions are made for adults will be included. The terms ‘critical’ and ‘intensive’ are often used interchangeably for clinical settings in which patients are seriously ill and/or require some form of life-sustaining treatment. | Clinical settings, in which EOL decision are made for children or neonates will be excluded. Non-critical/intensive care settings will be excluded. Other specialities or settings, in which EOL decisions are made (eg, community palliative care), will be excluded. |
| Methodologies | Qualitative studies examining conflict resolution in the AICU (eg, interviews and focus groups). Mixed-methods studies (eg, surveys with open questions) will also be included for consideration of the qualitative evidence presented. | Non-empirical studies examining conflict resolution. This may include normative and theoretical literature. These have been excluded as we are interested in understanding the lived reality of conflict resolution in clinical practice. Quantitative studies examining conflict resolution in the AICU. These have been excluded as we are interested in deeper exploration of experiences in the AICU, which is not possible using quantitative methods. |
| Issues | Qualitative studies exploring conflict resolution strategies within the AICU, around EOL decisions, will be included. EOL decisions are here defined as decisions relating to the withdrawal or withholding of life-sustaining treatment (eg, dialysis, clinically assisted nutrition and hydration, and artificial ventilation), or decisions relating to cardiopulmonary resuscitation. Conflict is here defined as a failure to reach an agreement on whether life-sustaining treatment should be withdrawn or withheld. The terms ‘conflict’, ‘dispute’, ‘disagreement’, ‘dissent’, and ‘refusal’ are often used interchangeably in the existing literature, and we are therefore interested in studies which explore any of these issues. | Literature that does not explore conflict, dispute, disagreement, dissent, and refusal will be excluded. Literature that does not explore withdrawal or withholding of life-sustaining treatment will be excluded. Empirical studies examining factors, which contribute to conflict, will be excluded. While the identification of factors which cause conflict is fundamental to the development of conflict resolution strategies, it is beyond the scope of this systematic review. |
| Participants | Studies which explore physician approaches to conflict resolution will be included. Studies which explore other stakeholders’ perceptions of physician approaches to conflict resolution will also be included. Stakeholders are broadly defined in three categories: (i) healthcare professionals (eg, physicians/doctors, nurses, and therapists), (ii) adult patients, and (iii) patient representatives (eg, families, spouses, relatives, and other surrogate decision-makers). | Literature that does not encompass discussion of stakeholders’ (as defined in the inclusion criteria) approaches to conflict in EOL decisions in the AICU, will be excluded. Literature that discusses non-physician-led approaches to conflict resolution, for example, clinical ethics consultation or independent mediation, will be excluded. |
| Timeframe | Any studies published after 2000 will be included, as critical care is a rapidly developing field. | Studies published before 2000 will be excluded, as they are less likely to be relevant to current clinical practice. |
| Types of publications | Peer-reviewed journal publications of empirical research. Publications in English. International publications will be included. | Unpublished and grey literature, theses, and dissertations, and any published sources that do not contain empirical studies will be excluded. Publications not in English will be excluded. Conference abstracts will be excluded. Review articles relating to the research question will be used for the identification of empirical studies only. Study authors will be contacted if we are unable to obtain the full text through the university subscription. If the study authors do not respond to this request within two weeks, the study will be excluded. |
AICU, adult intensive care unit; EOL, end-of-life.