Decision Aids and Shared Decision-Making in Neurocritical Care: An Unmet Need in Our NeuroICUs
Department of Neurology; Department of Quantitative Health Sciences
Brain Injuries; Critical Care; *Decision Making; *Decision Support Techniques; Humans; Intensive Care Units
Critical Care | Health Services Administration | Health Services Research | Neurology | Translational Medical Research
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.
DOI of Published Version
Neurocrit Care. 2015 Aug;23(1):127-30. doi: 10.1007/s12028-014-0097-2. Link to article on publisher's site
Muehlschlegel, Susanne; Shutter, Lori; Col, Nananda; and Goldberg, Robert J., "Decision Aids and Shared Decision-Making in Neurocritical Care: An Unmet Need in Our NeuroICUs" (2015). UMass Center for Clinical and Translational Science Supported Publications. 74.