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Article
Decision Aids and Shared Decision-Making in Neurocritical Care: An Unmet Need in Our NeuroICUs
UMass Center for Clinical and Translational Science Supported Publications
  • Susanne Muehlschlegel, University of Massachusetts Medical School
  • Lori Shutter, University of Pittsburgh Medical Center
  • Nananda Col, University of New England
  • Robert J. Goldberg, University of Massachusetts Medical School
UMMS Affiliation
Department of Neurology; Department of Quantitative Health Sciences
Date
8-1-2015
Document Type
Article
Medical Subject Headings
Brain Injuries; Critical Care; *Decision Making; *Decision Support Techniques; Humans; Intensive Care Units
Abstract
Improved resuscitation methods and advances in critical care have significantly increased the survival of patients presenting with devastating brain injuries compared to prior decades. After the patient's stabilization phase, families and patients are faced with "goals-of-care" decisions about continuation of aggressive intensive care unit care or comfort care only (CMO). Highly varying rates of CMO between centers raise the question of "self-fulfilling prophecies." Disease severity, the physician's communication and the family's understanding of projected outcomes, their uncertainties, complication risks with continued care, physician bias, and the patient's and surrogate's wishes and values all influence a CMO decision. Disease-specific decision support interventions, decision aids (DAs), may remedy these issues in the neurocritical care unit, potentially leading to better-informed and less-biased goals-of-care decisions in neurocritically ill patients, while increasing decision knowledge, confidence, and realistic expectations and decreasing decisional conflict and regret. Shared decision-making (SDM) is a collaborative process that enhances patients' and proxies' understanding about prognosis, encourages them to actively weigh the risks and benefits of a treatment, and considers the patient's preferences and values to make better decisions. DAs are SDM tools, which have been successfully implemented for many other conditions to assist difficult decision-making. In this article, we summarize the purposes of SDM, the derivation of DAs, and their potential application in neurocritical care.
Rights and Permissions
Citation: Neurocrit Care. 2015 Aug;23(1):127-30. doi: 10.1007/s12028-014-0097-2. Link to article on publisher's site
Related Resources
Link to Article in PubMed
Keywords
  • UMCCTS funding
PubMed ID
25561435
Citation Information
Susanne Muehlschlegel, Lori Shutter, Nananda Col and Robert J. Goldberg. "Decision Aids and Shared Decision-Making in Neurocritical Care: An Unmet Need in Our NeuroICUs" Vol. 23 Iss. 1 (2015) ISSN: 1541-6933 (Linking)
Available at: http://works.bepress.com/robert_goldberg/437/