Typologies of Decision-Makers in the ICU: A Qualitative Study of Patients With Acute Respiratory Distress Syndrome and Sepsis and Their Surrogates

• Type of Material: Article
• Authors: Michael S. Lava, Wellstar Health System; Gregory Martin, Emory University; Neal Dickert Jr, Emory University; Paula Frew, Emory University; Jonathan Sevransky, Emory University
• Language: English
• Date: 2019-05-23
• Publisher: Wolters Kluwer
• Publication Version: Final Published Version
• Copyright Statement: (c) 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/CCE.0000000000000011
• Title of Journal or Parent Work: Critical Care Explorations
• Volume: 1
• Issue: 5
• Start Page: e0011
• End Page: e0011
• Keywords: Critical Care; ARDS; Sepsis
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Objectives: To develop hypotheses of patient and surrogate’s rationale for decision-making. Design: We pursued a qualitative study of patients with acute respiratory distress syndrome or sepsis and their surrogates. Fourteen patients and 28 surrogates were given semistructured interviews while in the ICU and again 30 days later. The interviews focused on goal outcomes for the ICU stay and why a patient or surrogate would want a specific intervention (e.g., intubation and cardiopulmonary resuscitation). Setting: ICU of tertiary care academic hospital. Patients: Fourteen acute respiratory distress syndrome or sepsis patients and 28 of their surrogates. Interventions: None. Measurements and Main Results: Interviews were analyzed using grounded theory and the constant comparative method on NVivo 10.0 (QSR International, Melbourne, Australia). We identified the following four typologies of decision-making rationale: 1) “Timers”—determined decisions based on the length of time on life support; 2) “Natural Livers”—rejected interventions using a “machine”; 3) “Deferrers”—relied on physician for decision-making and prognosis; and 4) “Believers”—relied on a higher power for guidance. Conclusions: Our hypothesized typologies need validation in a prospective observational trial. If validated, they may allow for better clinician communication.