The value of uncertainty in critical illness? An ethnographic study of patterns and conflicts in care and decision-making trajectories

I. J. Higginson*, C. Rumble, C. Shipman, J. Koffman, K. E. Sleeman, M. Morgan, P. Hopkins, J. Noble, W. Bernal, S. Leonard, O. Dampier, W. Prentice, R. Burman, M. Costantini

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

33 Citations (Scopus)
210 Downloads (Pure)

Abstract

Background: With increasingly intensive treatments and population ageing, more people face complex treatment and care decisions. We explored patterns of the decision-making processes during critical care, and sources of conflict and resolution. 

Methods: Ethnographic study in two Intensive Care Units (ICUs) in an inner city hospital comprising: non-participant observation of general care and decisions, followed by case studies where treatment limitation decisions, comfort care and/or end of life discussions were occurring. These involved: semi-structured interviews with consenting families, where possible, patients; direct observations of care; and review of medical records. 

Results: Initial non-participant observation included daytime, evenings, nights and weekends. The cases were 16 patients with varied diagnoses, aged 19-87 years; 19 family members were interviewed, aged 30-73 years. Cases were observed for

Original languageEnglish
JournalAnesthesiology
Volume16
Issue number1
DOIs
Publication statusPublished - 9 Feb 2016

Keywords

  • Critical care
  • Decision-making
  • DNACPR
  • End-of-life care
  • Intensive care unit
  • Palliative care
  • Pathways
  • Uncertainty

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