Cognitive biases, environmental, patient and personal factors associated with critical care decision making: A scoping review

Critical care decision-making involves principles common to all medical decision-making. However, critical care is a remarkably distinctive form of clinical practice and therefore it may be useful to distinguish those elements particularly important or unique to ICU decision-making. The peculiar contextuality of critical care decision-making may be the best example of these elements. If so, attempts to improve our understanding of ICU decision-making may benefit from a formal analysis of its remarkable contextual nature. Four key elements of the context of critical care decisions can be identified: (1) costs, (2) time constraints, (3) the uncertain status of much clinical data, and (4) the continually changing environment of the ICU setting. These 4 elements comprise the context for the practice of clinical judgment in the ICU. The fact that intensivists are severely constrained by teh context of each case has important ramifications both for practice and for retrospective review. During retrospective review, the contextual nature of ICU judgment may be unfairly neglected by ignoring one or more of the key elements. Such neglect can be avoided if intensivists demand empathetic evaluation from reviewers.

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Adherence to advance directives in critical care decision making: vignette study

The Elderly ◽

10.4324/9781315240046-22 ◽

2017 ◽

pp. 213-216

Author(s):

Trevor Thompson ◽

Rosaline Barbour ◽

Lisa Schwartz

Keyword(s):

Decision Making ◽

Critical Care ◽

Advance Directives ◽

Vignette Study ◽

Care Decision

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Patient Engagement in Decision Making and Associated Factors among Outpatients with Selected Non-Communicable Chronic Diseases in Public Hospitals of West Shoa, Ethiopia,2020

10.21203/rs.3.rs-748294/v1 ◽

2021 ◽

Author(s):

Desalegn Emana

Keyword(s):

Health Care ◽

Decision Making ◽

Chronic Diseases ◽

Patient Engagement ◽

Associated Factors ◽

Public Hospitals ◽

Health Care Decision ◽

Factors Associated ◽

High Engagement ◽

Care Decision

Abstract Background: Despite the importance of patient engagement in health care decision-making in the care of patients with chronic diseases, there is limited information about it and the factors affecting it in Ethiopia in general and in the Public Hospitals of West Shoa in particular. Thus this study is designed to assess the engagement of patients with selected chronic non-communicable diseases in health care decision making and associated factors in public hospitals of West Shoa Zone, Oromia, Ethiopia.Methods: Facility-based cross-sectional study design was used. Systematic sampling was used for the selection of study participants from June 7 – July 26, 2020. Standardized, pretested, and structured Patient Activation Measure was used to measure patient engagement in healthcare decision-making. Descriptive analysis was done to determine the magnitude of patient engagement in health care decision-making. Multivariate logistic regression analysis was used to determine factors associated with patients’ engagement in the health care decision-making process. Adjusted odds ratio with a 95% confidence interval was calculated to measure the strength of association. Statistical significance was declared at p<0.05. The results were presented by tables and graphs.Results: A total of 406 patients with chronic diseases participated in the study yielding a response rate of 96.2%. Less than a fifth [19.5% (95% CI: 15.5, 23.6)] of participants in the study area had a high engagement in their health care decision-making. Educational level (college or above) [AOR=5.2, 95% CI (1.76-15.46)], duration of diagnosis >5 years [AOR= 1.8, 95% CI (1.03-3.2)], health literacy [AOR=1.15, 95% CI (1.06-1.24)], autonomy preference in decision making [AOR=1.35, 95% CI (1.03-1.96)] were factors significantly associated with participants’ engagement in health care decision making among patients with chronic diseases. Conclusion- Low number of respondents had a high engagement in their health care decision-making. Preference for autonomy in decision making, educational level, health literacy, duration of diagnosis with the disease were factors associated with patient engagement in health care decision making among patients with chronic diseases in the study area. Thus individualized patient-centered care and patient empowerment is essential among patients with chronic non-communicable diseases.

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Covid-19: Refracting decision-making through the prism of resource allocation

Medico-Legal Journal ◽

10.1177/0025817220935752 ◽

2020 ◽

Vol 88 (2) ◽

pp. 97-101

Author(s):

Richard WM Law ◽

Kartina A Choong

Keyword(s):

Decision Making ◽

Resource Allocation ◽

Critical Care ◽

Clinical Judgment ◽

Patient Autonomy ◽

Medical Decision Making ◽

Resource Constraints ◽

Medical Decision ◽

History Of ◽

Care Decision

Medical decision-making has, across the history of the NHS, made a transitional journey from a model characterised by paternalism to one which places emphasis on partnership and patient autonomy. This article assesses the extent to which the circumstances generated by the Covid-19 pandemic affect the mode of critical care decision-making. It observes that clinical judgment influenced by protocols, algorithms and resource constraints do not lend themselves to full identification with either of the two frameworks familiar to the NHS. The unique mode of decision-making engendered can only be understood on its own terms.

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Evaluating the Presence of Cognitive Biases in Health Care Decision Making: A Survey of U.S. Formulary Decision Makers

Journal of Managed Care & Specialty Pharmacy ◽

10.18553/jmcp.2018.24.11.1173 ◽

2018 ◽

Vol 24 (11) ◽

pp. 1173-1183

Author(s):

Dylan J. Mezzio ◽

Victor B. Nguyen ◽

Andrew Kiselica ◽

Ken O’Day

Keyword(s):

Health Care ◽

Decision Making ◽

Cognitive Biases ◽

Decision Makers ◽

Formulary Decision ◽

Health Care Decision ◽

Care Decision

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Intensive care decision-making: Identifying the challenges and generating solutions to improve inter-specialty referrals to critical care

Journal of the Intensive Care Society ◽

10.1177/1751143718758933 ◽

2018 ◽

Vol 19 (4) ◽

pp. 287-298 ◽

Cited By ~ 1

Author(s):

Nicola Power ◽

Nicholas R Plummer ◽

Jacqueline Baldwin ◽

Fiona R James ◽

Shondipon Laha

Keyword(s):

Intensive Care Unit ◽

Decision Making ◽

Intensive Care ◽

Clinical Decision Making ◽

Cognitive Biases ◽

Clinical Decision ◽

The Past ◽

Admission Decision ◽

Interviewing Technique ◽

Care Decision

Introduction Decision-making regarding admission to UK intensive care units is challenging. Demand for beds exceeds capacity, yet the need to provide emergency cover creates pressure to build redundancy into the system. Guidelines to aid clinical decision-making are outdated, resulting in an over-reliance on professional judgement. Although clinicians are highly skilled, there is variability in intensive care unit decision-making, especially at the inter-specialty level wherein cognitive biases contribute to disagreement. Method This research is the first to explore intensive care unit referral and admission decision-making using the Critical Decision Method interviewing technique. We interviewed intensive care unit ( n = 9) and non-intensive care unit ( n = 6) consultants about a challenging referral they had dealt with in the past where there was disagreement about the patient’s suitability for intensive care unit. Results We present: (i) a description of the referral pathway; (ii) challenges that appear to derail referrals (i.e. process issues, decision biases, inherent stressors, post-decision consequences) and (iii) potential solutions to improve this process. Discussion This research provides a foundation upon which interventions to improve inter-specialty decision-making can be based.

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