scholarly journals Toward Shared Decision Making at the End of Life in Intensive Care Units

2007 ◽  
Vol 167 (5) ◽  
pp. 461 ◽  
Author(s):  
Douglas B. White
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
End Of Life ◽  
Intensive Care Units ◽  
Shared Decision Making ◽  
Shared Decision

How individual ethical frameworks shape physician trainees’ experiences providing end-of-life care: a qualitative study

2021 ◽  
pp. medethics-2020-106690
Author(s):  
Sarah Rosenwohl-Mack ◽  
Daniel Dohan ◽  
Thea Matthews ◽  
Jason Neil Batten ◽  
Elizabeth Dzeng
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Shared Decision Making ◽  
End Of Life Care ◽  
The United States ◽  
Ethical Framework ◽  
Shared Decision ◽  
Life Care ◽  
Best Interest ◽  
Ethical Frameworks

ObjectivesThe end of life is an ethically challenging time requiring complex decision-making. This study describes ethical frameworks among physician trainees, explores how these frameworks manifest and relates these frameworks to experiences delivering end-of-life care.DesignWe conducted semistructured in-depth exploratory qualitative interviews with physician trainees about experiences of end-of-life care and moral distress. We analysed the interviews using thematic analysis.SettingAcademic teaching hospitals in the United States and United Kingdom.ParticipantsWe interviewed 30 physician trainees. We purposefully sampled across three domains we expected to be associated with individual ethics (stage of training, gender and national healthcare context) in order to elicit a diversity of ethical and experiential perspectives.ResultsSome trainees subscribed to a best interest ethical framework, characterised by offering recommendations consistent with the patient’s goals and values, presenting only medically appropriate choices and supporting shared decision-making between the patient/family and medical team. Others endorsed an autonomy framework, characterised by presenting all technologically feasible choices, refraining from offering recommendations and prioritising the voice of patient/family as the decision-maker.ConclusionsThis study describes how physician trainees conceptualise their roles as being rooted in an autonomy or best interest framework. Physician trainees have limited clinical experience and decision-making autonomy and may have ethical frameworks that are dynamic and potentially highly influenced by experiences providing end-of-life care. A better understanding of how individual physicians’ ethical frameworks influences the care they give provides opportunities to improve patient communication and advance the role of shared decision-making to ensure goal-aligned end-of-life care.

scholarly journals Physician Self-assessment of Shared Decision-making in Simulated Intensive Care Unit Family Meetings

2020 ◽  
Vol 3 (5) ◽  
pp. e205188 ◽  
Author(s):  
Scott T. Vasher ◽  
Ian M. Oppenheim ◽  
Pragyashree Sharma Basyal ◽  
Emma M. Lee ◽  
Margaret M. Hayes ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Self Assessment ◽  
Family Meetings

The importance of shared decision-making in the neonatal intensive care unit

2019 ◽  
Vol 40 (3) ◽  
pp. 504-509 ◽  
Author(s):  
Frank Soltys ◽  
Sydney E. Philpott-Streiff ◽  
Lindsay Fuzzell ◽  
Mary C. Politi
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Shared Decision Making ◽  
Neonatal Intensive Care ◽  
Shared Decision
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