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

doi:10.1186/s12871-016-0177-2

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

Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation

Research output: Contribution to journal › Article › peer-review

34 Citations (Scopus)

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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 language	English
Journal	Anesthesiology
Volume	16
Issue number	1
DOIs	https://doi.org/10.1186/s12871-016-0177-2
Publication status	Published - 9 Feb 2016

Keywords

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

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10.1186/s12871-016-0177-2Licence: CC BY

The value of uncertainty_HIGGINSON_Accepted 1Feb2016_GOLD VoRFinal published version, 505 KBLicence: CC BY

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Higginson, I. J., Rumble, C., Shipman, C., Koffman, J., Sleeman, K. E., Morgan, M., Hopkins, P., Noble, J., Bernal, W., Leonard, S., Dampier, O., Prentice, W., Burman, R., & Costantini, M. (2016). The value of uncertainty in critical illness? An ethnographic study of patterns and conflicts in care and decision-making trajectories. Anesthesiology, 16(1). https://doi.org/10.1186/s12871-016-0177-2

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Higginson, IJ , Rumble, C , Shipman, C , Koffman, J , Sleeman, KE , Morgan, M, Hopkins, P, Noble, J, Bernal, W, Leonard, S, Dampier, O, Prentice, W , Burman, R & Costantini, M 2016, 'The value of uncertainty in critical illness? An ethnographic study of patterns and conflicts in care and decision-making trajectories', Anesthesiology, vol. 16, no. 1. https://doi.org/10.1186/s12871-016-0177-2

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AU - Koffman, J.

AU - Sleeman, K. E.

AU - Morgan, M.

AU - Hopkins, P.

AU - Noble, J.

AU - Bernal, W.

AU - Leonard, S.

AU - Dampier, O.

AU - Prentice, W.

AU - Burman, R.

AU - Costantini, M.

PY - 2016/2/9

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

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