Values, preferences and goals identified during shared decision making between critically ill patients and their doctors

Sharyn L Milnes; Yianni Mantzaridis; Nicholas B Simpson; Trisha L Dunning; Debra C Kerr; Joan B Ostaszkiewicz; Gerry T Keely; Charlie Corke; Neil R Orford

doi:10.51893/2021.1.OA7

Values, preferences and goals identified during shared decision making between critically ill patients and their doctors

Crit Care Resusc. 2023 Oct 18;23(1):76-85. doi: 10.51893/2021.1.OA7. eCollection 2021 Mar.

Authors

Sharyn L Milnes^{1

2

3}, Yianni Mantzaridis¹, Nicholas B Simpson^{1

3}, Trisha L Dunning², Debra C Kerr², Joan B Ostaszkiewicz⁴, Gerry T Keely¹, Charlie Corke¹, Neil R Orford^{1

3

5}

Affiliations

¹ University Hospital Geelong, Barwon Health, Geelong, Australia.
² Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Geelong, Australia.
³ School of Medicine, Deakin University, Geelong, Australia.
⁴ National Ageing Research Institute, Melbourne, VIC, Australia.
⁵ Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.

Abstract

Objective: Examine values, preferences and goals elicited by doctors following goals-of-care (GOC) discussions with critically ill patients who had life-limiting illnesses. Design: Descriptive qualitative study using four-stage latent content analysis. Setting: Tertiary intensive care unit (ICU) in South Western Victoria. Participants: Adults who had life-limiting illnesses and were admitted to the ICU with documented GOC, between October 2016 and July 2018. Intervention: The iValidate program, a shared decision-making clinical communication education and clinical support program, for all ICU registrars in August 2015. Main outcome measures: Matrix of themes and subthemes categorised into values, preferences and goals. Results: A total of 354 GOC forms were analysed from 218 patients who had life-limiting illnesses and were admitted to the ICU. In the categories of values, preferences and goals, four themes were identified: connectedness and relational autonomy, autonomy of decision maker, balancing quality and quantity of life, and physical comfort. The subthemes - relationships, sense of place, enjoyment of activities, independence, dignity, cognitive function, quality of life, longevity and physical comfort - provided a matrix of issues identified as important to patients. Relationship, place, independence and physical comfort statements were most frequently identified; longevity was least frequently identified. Conclusion: Our analysis of GOC discussions between medical staff and patients who had life-limiting illnesses and were admitted to the ICU, using a shared decision-making training and support program, revealed a framework of values, preferences and goals that could provide a structure to assist clinicians to engage in shared decision making.