UK consultants’ experiences of the decision-making process around referral to intensive care : an interview study

• 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.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap -- Medicinsk etik (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Medical Ethics (hsv//eng)

Nyckelord

Critical care

Clinical Decision-making

Clinical Ethics

Ethical Theory

Physicians

Medicin

Medicine

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)