European geriatric medicine · 2026
Intensive care under uncertainty: a qualitative study of how older patients and their relatives wish to contribute to decision-making.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Schwarz Gabriele Leonie, Sjøbø Britt Ågot, Skaar Elisabeth, Miljeteig Ingrid, Kvåle Reidar, Flaatten Hans, Burns Karen E A, Han Paul K J, Schaufel Margrethe
Аннотация
PURPOSE: Given the importance of shared decision-making in critical illness in advanced age, we aimed to explore how very old patients and their next of kin envision their contribution to the decision-making process.
METHODS: From November 2021 to March 2023, we conducted a survey among Norwegian outpatients aged 80 and over and their next of kin. We studied their perspectives on hypothetical scenarios of acute, life-threatening illness warranting admission to the intensive care unit (ICU). In this sub-study, we conducted cross-case thematic analysis of free-text responses addressing patients' and next-of-kins' participation in shared decision-making.
RESULTS: Of 202 very old and 153 next-of-kin respondents, 210 participants provided 339 free-text comments relevant to this research question. Vi identified five main categories, describing how participants wished to contribute to the decision process: (1) Seeking scientific knowledge, (2) Contributing personal knowledge, (3) Tailoring care to the heterogeneity of older age, (4) Improving the process of decision-making, and (5) Strengthening security. Applying a framework for medical uncertainty and uncertainty tolerance, we found that all five of them comprised ways of coping with or adapting to the multidimensional uncertainty characterising clinical decisions when very old patients fall critically ill.
CONCLUSION: These findings highlight the need to include patients' and family members' personal knowledge in clinical decision-making, and to facilitate the presence of next of kin when very old patients require critical care.
TRAIL REGISTRATION: ClinicalTrails.gov NCT05149040 (October 31, 2021).
METHODS: From November 2021 to March 2023, we conducted a survey among Norwegian outpatients aged 80 and over and their next of kin. We studied their perspectives on hypothetical scenarios of acute, life-threatening illness warranting admission to the intensive care unit (ICU). In this sub-study, we conducted cross-case thematic analysis of free-text responses addressing patients' and next-of-kins' participation in shared decision-making.
RESULTS: Of 202 very old and 153 next-of-kin respondents, 210 participants provided 339 free-text comments relevant to this research question. Vi identified five main categories, describing how participants wished to contribute to the decision process: (1) Seeking scientific knowledge, (2) Contributing personal knowledge, (3) Tailoring care to the heterogeneity of older age, (4) Improving the process of decision-making, and (5) Strengthening security. Applying a framework for medical uncertainty and uncertainty tolerance, we found that all five of them comprised ways of coping with or adapting to the multidimensional uncertainty characterising clinical decisions when very old patients fall critically ill.
CONCLUSION: These findings highlight the need to include patients' and family members' personal knowledge in clinical decision-making, and to facilitate the presence of next of kin when very old patients require critical care.
TRAIL REGISTRATION: ClinicalTrails.gov NCT05149040 (October 31, 2021).