Decision-Making in the ICU - The Problem Is Us

byDrew Rosielle (@drosielle)Annals of Internal Medicine has published a fascinating trial of a web-based surrogate decision-making tool aimed at improving decisions for patients receiving prolonged mechanical ventilation in an ICU.It ' s one of the most fascinating trials I ' ve read in a long time, and also somewhat of a monster (in size/scope of data presented) - there are 4, lengthy online supplements attached to it (!), which is daunting, and so I ' m mostly just going to write here about what I find most interesting about it.Which is that I think this may be the trial which should convince us all that what ' s ' wrong ' with ICU decision-making is not a lack of sharing good information -- what is wrong is our entire approach to surrogate decision making.First the trial, briefly summarized. This was a randomized trial of a personalized, web-based decision aid for surrogate decision makers of patients with prolonged mechanical ventilation. It took place in several ( mostly academic medical center) ICUs in the US. The subjects were primary or secondary surrogates of actual ICU patients (~280 patients in total), all of whom had been mechanically ventilated for 10 days at least, and weren ’t anticipated to be immediately extubatable.The main intervention was that the surrogates received and were asked to interact with a personalized, web-based decision aid tool, which is a fascinating thing that I hope to be able to see in action one day (they have many screen shots in the ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Care Tags: advance care planning annals of internal medicine communication hospital icu journal article prognosis rosielle The profession Source Type: blogs