A Decision Aid to Support Shared Decision Making About Mechanical Ventilation in Severe Chronic Obstructive Pulmonary Disease Patients (InformedTogether): Feasibility Study

BACKGROUND Severe Chronic Obstructive Pulmonary Disease patients are often unprepared to make decisions about accepting intubation for respiratory failure. We developed a Web-based decision aid, InformedTogether, to facilitate severe Chronic Obstructive Pulmonary Disease patients’ preparation for decision making about whether to accept invasive mechanical ventilation for respiratory failure. OBJECTIVE We describe feasibility testing of the InformedTogether decision aid. METHODS Mixed methods, pre- and postintervention feasibility study in outpatient pulmonary and geriatric clinics. Clinicians used InformedTogether with severe Chronic Obstructive Pulmonary Disease patients. Patient-participants completed pre- and postassessments about InformedTogether use. The outcomes measured were the following: feasibility/acceptability, communication (Combined Outcome Measure for Risk Communication [COMRADE], Medical Communication Competency Scale [MCCS], Observing Patient Involvement [OPTION] scales), and effectiveness of InformedTogether on changing patients' knowledge, Decisional Conflict Scale, and motivation. RESULTS We enrolled 11 clinicians and 38 Chronic Obstructive Pulmonary Disease patients at six sites. Feasibility/acceptability: Clinicians and patients gave positive responses to acceptability questions (mean 74.1/89 max [SD 7.24] and mean 59.63/61 [SD 4.49], respectively). Communication: 96% of clinicians stated InformedTogether improved communication (modified MCCS mean 44.54/49 [SD 2.97]; mean OPTION score 32.03/48 [SD 9.27]; mean COMRADE Satisfaction 4.31/5.0 [SD 0.58]; and COMRADE Confidence 4.18/5.0 [SD 0.56]). Preference: Eighty percent of patients discussed preferences with their surrogates by 1-month. Effectiveness: Knowledge scores increased significantly after using InformedTogether (mean difference 3.61 [SD 3. 44], P=.001) and Decisional Conflict decreased (mean difference Decisional Conflict Scale pre/post -13.76 [SD 20.39], P=.006). Motivation increased after viewing the decision aid. CONCLUSIONS InformedTogether supports high-quality communication and shared decision making among Chronic Obstructive Pulmonary Disease patients, clinicians, and surrogates. The increased knowledge and opportunity to deliberate and discuss treatment choices after using InformedTogether should lead to improved decision making at the time of critical illness.

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Evaluation of a decision aid for making choices about intubation and mechanical ventilation in chronic obstructive pulmonary disease

Patient Education and Counseling ◽

10.1016/j.pec.2004.04.004 ◽

2005 ◽

Vol 57 (1) ◽

pp. 88-95 ◽

Cited By ~ 26

Author(s):

Keith G. Wilson ◽

Shawn D. Aaron ◽

Katherine L. Vandemheen ◽

Paul C. Hébert ◽

Douglas A. McKim ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Mechanical Ventilation ◽

Pulmonary Disease ◽

Decision Aid ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Making Choices

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Nurses’ role and care practices in decision-making regarding artificial ventilation in late stage pulmonary disease

Nursing Ethics ◽

10.1177/0969733015626600 ◽

2016 ◽

Vol 24 (7) ◽

pp. 821-832 ◽

Cited By ~ 2

Author(s):

Heidi Jerpseth ◽

Vegard Dahl ◽

Per Nortvedt ◽

Kristin Halvorsen

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Decision Making ◽

Mechanical Ventilation ◽

Pulmonary Disease ◽

Research Question ◽

Interdisciplinary Cooperation ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Decision Making Processes ◽

Treatment Culture

Background: Decisions regarding whether or not to institute mechanical ventilation during the later stages of chronic obstructive pulmonary disease is challenging both ethically, emotionally and medically. Caring for these patients is a multifaceted process where nurses play a crucial role. Research question and design: We have investigated how nurses experienced their own role in decision-making processes regarding mechanical ventilation in later stages of chronic obstructive pulmonary disease and how they consider the patients’ role in these processes. We applied a qualitative approach, with six focus-group interviews of nurses (n = 26). Ethical considerations: The Regional Committees for Medical and Health Research Ethics approved the study. Voluntary informed consent was obtained. Findings: The nurses found themselves operating within a cure-directed treatment culture wherein they were unable to stand up for the caring values. They perceived their roles and responsibilities in decision-making processes regarding mechanical ventilation to patients as unclear and unsatisfactory. They also experienced inadequate interdisciplinary cooperation. Discussion: Lack of communication skills, the traditional hierarchical hospital culture together with operating in a medical-orientated treatment culture where caring values is rated as less important might explain the nurses’ absence in participation in the decision about mechanical ventilation. Conclusion: To be able to advocate for the patients’ and their own right to be included in decision-making processes, nurses need an awareness of their own responsibilities. This requires personal courage, leadership who are capable of organising common interpersonal meetings and willingness on the part of the physicians to include and value the nurses’ participation in decision-making processes.

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