A universal decision support system. Addressing the decision-making needs of patients, families, and clinicians in the setting of critical illness

Am J Respir Crit Care Med. 2014 Aug 15;190(4):366-73. doi: 10.1164/rccm.201404-0728CP.


In the setting of a complex critical illness, preference-sensitive decision making-choosing between two or more reasonable treatment options-can be difficult for patients, families, and clinicians alike. A common challenge to making high-quality decisions in this setting is a lack of critical information access and sharing among participants. Decision aids-brochures, web applications, and videos-are a major focus of current research because mounting evidence suggests they can improve decision-making quality and enhance collaborative shared decision making. However, many decision aids have important limitations, including a relatively narrow capacity for personalization, an inability to gather and generate clinical data, a focus on only a single disease or treatment, and high developmental costs. To address these issues and to help guide future research, we propose a model of "universal" electronic decision support that can be easily adapted by clinicians and patients/families for whatever decision is at hand. In this scalable web-based platform, a general shared decision-making core structure would accommodate simple, interchangeable disease and treatment information modules. The format and content of the system could be adapted to decisional participants' unique characteristics, abilities, and needs. Universal decision support can better standardize a decisional approach and also allow a unique degree of personalization within a framework of shared decision making. We also discuss potential criticisms of this approach as well as strategies that can overcome them in a critical illness setting.

Keywords: critical illness; decision support; patient-centeredness; shared decision making; surrogate decision making.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Communication
  • Cooperative Behavior
  • Critical Illness / therapy*
  • Decision Support Systems, Clinical / organization & administration*
  • Decision Support Techniques*
  • Family
  • Health Services Needs and Demand / organization & administration*
  • Humans
  • Patient Participation / methods*
  • Patient-Centered Care / methods*
  • Professional-Patient Relations*