scholarly journals Decision-Making Processes in Surrogates of Cancer Patients in a Taiwan Intensive Care Unit

2020 ◽  
Vol 17 (12) ◽  
pp. 4443 ◽  
Author(s):  
Wan-Na Sun ◽  
Hsin-Tien Hsu ◽  
Nai-Ying Ko ◽  
Yu-Tung Huang
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Cancer Patients ◽  
Medical Center ◽  
Medical Decision ◽  
Confined Space ◽  
Asian Populations ◽  
Decision Making Processes ◽  
Purposive Sample

Background: Few studies in Asian countries have explored the emotional entanglements and conflicts that surrogates often experience during the medical decision-making process. This study was to explore decision-making processes in surrogates of cancer patients in a Taiwan intensive care unit (ICU). This qualitative study surveyed a purposive sample of surrogates (n = 8; average age, 48 years) of cancer patients in the ICU of a medical center in Taiwan. A phenomenological methodology was used, and a purposive sample of surrogates of cancer patients were recruited and interviewed during the first three days of the ICU stay. Results: Based on the interview results, four themes were generalized through text progression: (1) Use love to resist: internal angst. This theme was related to the reflexive self -blame, the feelings of inner conflict, and the reluctance to make healthcare decisions, which surrogates experienced when they perceived suffering by the patient. (2) Allow an angel to spread love among us: memories and emotional entanglements. Memories of the patient caused the surrogate to experience emotional entanglements ranging from happiness to sadness and from cheerfulness to anger. (3) Dilemmas of love: anxiety about ICU visitor restrictions. The confined space and restricted visiting hours of the ICU limited the ability of surrogates to provide emotional support and to share their emotions with the patient. (4) Suffocating love: entanglement in decision-making. Emotional entanglements among family members with different opinions on medical care and their struggles to influence decision-making often prevented surrogates from thinking logically. Conclusions: Expression of emotions by ICU surrogates is often restrained and implicit, particularly in Asian populations. These results can help health professionals understand the psychological shock and inner conflict experienced by surrogates and provide a useful reference for improving their communications with surrogates.

scholarly journals End-of-life decision making for cancer patients in an intensive care unit

2015 ◽  
Vol 3 (S1) ◽  
Author(s):  
M Tavares ◽  
I Neves ◽  
F Coelho ◽  
O Afonso ◽  
A Martins ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
End Of Life ◽  
Cancer Patients ◽  
End Of Life Decision ◽  
Life Decision

Palliative Considerations for the Patient With Acute Kidney Injury in the Intensive Care Unit

2020 ◽  
pp. 197-208
Author(s):  
Tamara Rubenzik ◽  
Alvin H. Moss
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Palliative Care ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Kidney Injury ◽  
Medical Decision ◽  
High Morbidity ◽  
Shared Decision ◽  
Care Approach

Acute kidney injury is a common occurrence in the intensive care unit and one that is associated with a high morbidity and mortality. One role for palliative care is to guide medical decision-making regarding management of patients with acute kidney injury. This role can be fulfilled as part of primary palliative care by the intensive care unit and nephrology teams or by specialist palliative care clinicians if there is a need for assistance with conflict resolution. In such discussions, it is important to understand the patient’s prognosis and values, preferences, and goals to inform the shared decision-making discussion about whether to initiate or continue renal replacement therapy. This chapter reviews the literature and guideline recommendations on a palliative care approach to managing critically ill patients with acute kidney injury.

First Come, First Served in the Intensive Care Unit: Always?

2017 ◽  
Vol 27 (1) ◽  
pp. 52-61 ◽  
Author(s):  
LEONARD M. FLECK ◽  
TIMOTHY F. MURPHY
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Ethical Issues ◽  
Clinical Care ◽  
Level Of Care ◽  
Medical Group ◽  
Voluntary Withdrawal ◽  
Decision Making Processes

Abstract:Because the demand for intensive care unit (ICU) beds exceeds the supply in general, and because of the formidable costs of that level of care, clinicians face ethical issues when rationing this kind of care not only at the point of admission to the ICU, but also after the fact. Under what conditions—if any—may patients be denied admission to the ICU or removed after admission? One professional medical group has defended a rule of “first come, first served” in ICU admissions, and this approach has numerous moral considerations in its favor. We show, however, that admission to the ICU is not in and of itself guaranteed; we also show that as a matter of principle, it can be morally permissible to remove certain patients from the ICU, contrary to the idea that because they were admitted first, they are entitled to stay indefinitely through the point of recovery, death, or voluntary withdrawal. What remains necessary to help guide these kinds of decisions is the articulation of clear standards for discontinuing intensive care, and the articulation of these standards in a way consistent with not only fiduciary and legal duties that attach to clinical care but also with democratic decision making processes.

scholarly journals Difficult Decisions in the Intensive Care Unit: An Illustrative Case

2007 ◽  
Vol 35 (5) ◽  
pp. 748-759 ◽  
Author(s):  
D. A. Freshwater-Turner ◽  
R. J. Boots ◽  
R. N. Bowman ◽  
H. G. Healy ◽  
A. C. Klestov
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Clinical Evidence ◽  
Clinical Decision Making ◽  
Disease Process ◽  
Clinical Decision ◽  
Medical Decision ◽  
Illustrative Case ◽  
Stressful Environment

Difficult clinical decision-making is a common experience in intensive care units. There is often considerable pressure on time and decisions may have to be made in a stressful environment. Patients in the intensive care unit not infrequently present with extreme or rare manifestations of a disease process. Clinical evidence to guide management of such patients may be incomplete, non-existent, or its relevance to the problem at hand may be questionable. In this context, formal decision-making analytical tools are often impractical. Unconscious cognitive biases have been shown to play an important role in medical decision-making, particularly in these settings. While mostly these contribute to doctors making appropriate and timely decisions, occasionally they lead to errors. Despite 30 years of research into models of clinical reasoning, most doctors are unaware of how biases affect their thinking and are unfamiliar with techniques of detecting and neutralising bias in clinical practice. We present the case of a patient with Wegener's granulomatosis, which highlights many of the difficulties outlined above. We review the clinical evidence for our decisions at each stage and explain the rationale for our choices, highlighting the many situations for which high quality evidence was lacking. Examples of cognitive bias are identified and techniques of metacognition (thinking about thinking) that can be useful in limiting the effects of bias on complex decision-making are reviewed. The intensivist's evaluation of management alternatives has an important role in steering medical management towards optimal patient outcomes.

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