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UK consultants’ exp...
UK consultants’ experiences of the decision-making process around referral to intensive care : an interview study
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- Heidenreich, Kaja, 1973- (author)
- Örebro universitet,Institutionen för medicinska vetenskaper,University Health Care Research Center,Örebro University, Sweden
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- Slowther, Anne-Marie (author)
- Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
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- Griffiths, Frances (author)
- Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
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- Bremer, Anders, Docent, 1957- (author)
- Linnéuniversitetet,Institutionen för hälso- och vårdvetenskap (HV),iCARE,Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
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- Svantesson, Mia, 1960- (author)
- Örebro universitet,Institutionen för hälsovetenskaper,Region Örebro län,University Health Care Research Center,Örebro University, Sweden
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(creator_code:org_t)
- 2021-03-24
- 2021
- English.
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In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 11:3
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https://bmjopen.bmj....
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Abstract
Subject headings
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- Objective: The decision whether to initiate intensivecare for the critically ill patient involves ethical questions regarding what is good and right for the patient. It isnot clear how referring doctors negotiate these issuesin practice. The aim of this study was to describe and understand consultants’ experiences of the decision- making process around referral to intensive care.Design: Qualitative interviews were analysed according to a phenomenological hermeneutical method.Setting and participants: Consultant doctors (n=27) from departments regularly referring patients to intensive care in six UK hospitals.Results: In the precarious and uncertain situation of critical illness, trust in the decision-making process is needed and can be enhanced through the way in which the process unfolds. When there are no obvious right or wrong answers as to what ought to be done, how the decision is made and how the process unfolds is morally important. Through acknowledging the burdensome doubts in the process, contributing to an emerging, joint understanding of the patient’s situation, and respondingto mutual moral duties of the doctors involved, trust in the decision-making process can be enhanced and a shared moral responsibility between the stake holding doctors can be assumed.Conclusion: The findings highlight the importance of trust in the decision-making process and how the relationships between the stakeholding doctors are crucial to support their moral responsibility for the patient. Poor interpersonal relationships can damage trust and negatively impact decisions made on behalf of a critically ill patient. Forthis reason, active attempts must be made to foster good relationships between doctors. This is not only important to create a positive working environment, but a mechanism to improve patient outcomes.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Medicinsk etik (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Medical Ethics (hsv//eng)
Keyword
- Critical care
- Clinical Decision-making
- Clinical Ethics
- Ethical Theory
- Physicians
- Medicin
- Medicine
Publication and Content Type
- ref (subject category)
- art (subject category)
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