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A case for preference-sensitive decision timelines to aid shared decision-making in intensive care: need and possible application

In the intensive care unit, it can be challenging to determine which interventions align with the patients' preferences since patients are often incapacitated and other sources, such as advance directives and surrogate input, are integral. Managing treatment decisions in this context requires a...

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Autores principales: Göcking, Beatrix, Gloeckler, Sophie, Ferrario, Andrea, Brandi, Giovanna, Glässel, Andrea, Biller-Andorno, Nikola
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10595152/
https://www.ncbi.nlm.nih.gov/pubmed/37881363
http://dx.doi.org/10.3389/fdgth.2023.1274717
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author Göcking, Beatrix
Gloeckler, Sophie
Ferrario, Andrea
Brandi, Giovanna
Glässel, Andrea
Biller-Andorno, Nikola
author_facet Göcking, Beatrix
Gloeckler, Sophie
Ferrario, Andrea
Brandi, Giovanna
Glässel, Andrea
Biller-Andorno, Nikola
author_sort Göcking, Beatrix
collection PubMed
description In the intensive care unit, it can be challenging to determine which interventions align with the patients' preferences since patients are often incapacitated and other sources, such as advance directives and surrogate input, are integral. Managing treatment decisions in this context requires a process of shared decision-making and a keen awareness of the preference-sensitive instances over the course of treatment. The present paper examines the need for the development of preference-sensitive decision timelines, and, taking aneurysmal subarachnoid hemorrhage as a use case, proposes a model of one such timeline to illustrate their potential form and value. First, the paper draws on an overview of relevant literature to demonstrate the need for better guidance to (a) aid clinicians in determining when to elicit patient preference, (b) support the drafting of advance directives, and (c) prepare surrogates for their role representing the will of an incapacitated patient in clinical decision-making. This first section emphasizes that highlighting when patient (or surrogate) input is necessary can contribute valuably to shared decision-making, especially in the context of intensive care, and can support advance care planning. As an illustration, the paper offers a model preference-sensitive decision timeline—whose generation was informed by existing guidelines and a series of interviews with patients, surrogates, and neuro-intensive care clinicians—for a use case of aneurysmal subarachnoid hemorrhage. In the last section, the paper offers reflections on how such timelines could be integrated into digital tools to aid shared decision-making.
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spelling pubmed-105951522023-10-25 A case for preference-sensitive decision timelines to aid shared decision-making in intensive care: need and possible application Göcking, Beatrix Gloeckler, Sophie Ferrario, Andrea Brandi, Giovanna Glässel, Andrea Biller-Andorno, Nikola Front Digit Health Digital Health In the intensive care unit, it can be challenging to determine which interventions align with the patients' preferences since patients are often incapacitated and other sources, such as advance directives and surrogate input, are integral. Managing treatment decisions in this context requires a process of shared decision-making and a keen awareness of the preference-sensitive instances over the course of treatment. The present paper examines the need for the development of preference-sensitive decision timelines, and, taking aneurysmal subarachnoid hemorrhage as a use case, proposes a model of one such timeline to illustrate their potential form and value. First, the paper draws on an overview of relevant literature to demonstrate the need for better guidance to (a) aid clinicians in determining when to elicit patient preference, (b) support the drafting of advance directives, and (c) prepare surrogates for their role representing the will of an incapacitated patient in clinical decision-making. This first section emphasizes that highlighting when patient (or surrogate) input is necessary can contribute valuably to shared decision-making, especially in the context of intensive care, and can support advance care planning. As an illustration, the paper offers a model preference-sensitive decision timeline—whose generation was informed by existing guidelines and a series of interviews with patients, surrogates, and neuro-intensive care clinicians—for a use case of aneurysmal subarachnoid hemorrhage. In the last section, the paper offers reflections on how such timelines could be integrated into digital tools to aid shared decision-making. Frontiers Media S.A. 2023-10-10 /pmc/articles/PMC10595152/ /pubmed/37881363 http://dx.doi.org/10.3389/fdgth.2023.1274717 Text en © 2023 Göcking, Gloeckler, Ferrario, Brandi, Glässel and Biller-Andorno. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Digital Health
Göcking, Beatrix
Gloeckler, Sophie
Ferrario, Andrea
Brandi, Giovanna
Glässel, Andrea
Biller-Andorno, Nikola
A case for preference-sensitive decision timelines to aid shared decision-making in intensive care: need and possible application
title A case for preference-sensitive decision timelines to aid shared decision-making in intensive care: need and possible application
title_full A case for preference-sensitive decision timelines to aid shared decision-making in intensive care: need and possible application
title_fullStr A case for preference-sensitive decision timelines to aid shared decision-making in intensive care: need and possible application
title_full_unstemmed A case for preference-sensitive decision timelines to aid shared decision-making in intensive care: need and possible application
title_short A case for preference-sensitive decision timelines to aid shared decision-making in intensive care: need and possible application
title_sort case for preference-sensitive decision timelines to aid shared decision-making in intensive care: need and possible application
topic Digital Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10595152/
https://www.ncbi.nlm.nih.gov/pubmed/37881363
http://dx.doi.org/10.3389/fdgth.2023.1274717
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