Andrej Michalsen1, Ann C Long2,3, Freda DeKeyser Ganz4, Douglas B White5, Hanne I Jensen6,7, Victoria Metaxa8, Christiane S Hartog9,10, Jos M Latour11, Robert D Truog12, Jozef Kesecioglu13, Anna R Mahn10, J Randall Curtis2,3. 1. Department of Anaesthesiology and Critical Care, Medizin Campus Bodensee - Tettnang Hospital, Tettnang, Germany. 2. Harborview Medical Center, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA. 3. Cambia Palliative Care Center of Excellence, Harborview Medical Center, Department of Medicine, University of Washington, Seattle, WA. 4. Hadassah Hebrew University School of Nursing, Jerusalem, Israel. 5. Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. 6. Departments of Anaesthesiology and Intensive Care, Lillebaelt Hospital, Vejle, Denmark. 7. Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark. 8. Department of Critical Care, King's College Hospital NHS Foundation Trust, London, United Kingdom. 9. Patient- and Family-Centered Care, Klinik Bavaria Kreischa, Kreischa, Germany. 10. Department of Anesthesiology and Operative Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany. 11. School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, United Kingdom. 12. Center for Bioethics, Harvard, Medical School, as well as Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA. 13. Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Abstract
OBJECTIVES: There is growing recognition that high-quality care for patients and families in the ICU requires exemplary interprofessional collaboration and communication. One important aspect is how the ICU team makes complex decisions. However, no recommendations have been published on interprofessional shared decision-making. The aim of this project is to use systematic review and normative analysis by experts to examine existing evidence regarding interprofessional shared decision-making, describe its principles and provide ICU clinicians with recommendations regarding its implementation. DATA SOURCES: We conducted a systematic review using MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases and used normative analyses to formulate recommendations regarding interprofessional shared decision-making. STUDY SELECTION: Three authors screened titles and abstracts in duplicate. DATA SYNTHESIS: Four papers assessing the effect of interprofessional shared decision-making on quality of care were identified, suggesting that interprofessional shared decision-making is associated with improved processes and outcomes. Five recommendations, largely based on expert opinion, were developed: 1) interprofessional shared decision-making is a collaborative process among clinicians that allows for shared decisions regarding important treatment questions; 2) clinicians should consider engaging in interprofessional shared decision-making to promote the most appropriate and balanced decisions; 3) clinicians and hospitals should implement strategies to foster an ICU climate oriented toward interprofessional shared decision-making; 4) clinicians implementing interprofessional shared decision-making should consider incorporating a structured approach; and 5) further studies are needed to evaluate and improve the quality of interprofessional shared decision-making in ICUs. CONCLUSIONS: Clinicians should consider an interprofessional shared decision-making model that allows for the exchange of information, deliberation, and joint attainment of important treatment decisions.
OBJECTIVES: There is growing recognition that high-quality care for patients and families in the ICU requires exemplary interprofessional collaboration and communication. One important aspect is how the ICU team makes complex decisions. However, no recommendations have been published on interprofessional shared decision-making. The aim of this project is to use systematic review and normative analysis by experts to examine existing evidence regarding interprofessional shared decision-making, describe its principles and provide ICU clinicians with recommendations regarding its implementation. DATA SOURCES: We conducted a systematic review using MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases and used normative analyses to formulate recommendations regarding interprofessional shared decision-making. STUDY SELECTION: Three authors screened titles and abstracts in duplicate. DATA SYNTHESIS: Four papers assessing the effect of interprofessional shared decision-making on quality of care were identified, suggesting that interprofessional shared decision-making is associated with improved processes and outcomes. Five recommendations, largely based on expert opinion, were developed: 1) interprofessional shared decision-making is a collaborative process among clinicians that allows for shared decisions regarding important treatment questions; 2) clinicians should consider engaging in interprofessional shared decision-making to promote the most appropriate and balanced decisions; 3) clinicians and hospitals should implement strategies to foster an ICU climate oriented toward interprofessional shared decision-making; 4) clinicians implementing interprofessional shared decision-making should consider incorporating a structured approach; and 5) further studies are needed to evaluate and improve the quality of interprofessional shared decision-making in ICUs. CONCLUSIONS: Clinicians should consider an interprofessional shared decision-making model that allows for the exchange of information, deliberation, and joint attainment of important treatment decisions.
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