Shared decision-making in the intensive care unit requires more frequent and high-quality communication: A research critique
Bibliographic record
Abstract
Informing and actively involving patients and their families in decision-making is a goal of patient- and family-centred health care. [1] Cai X. Robinson J. Muehlschlegel S. White D.B. Holloway R.G. Sheth K.N. et al. Patient preferences and surrogate decision making in neuroscience intensive care units. Neurocritical Care. 2015; 23 (Epub 2015/05/21; PubMed PMID: 25990137; PubMed Central PMCID: PMCPmc4816524): 131-141https://doi.org/10.1007/s12028-015-0149-2 Crossref PubMed Scopus (39) Google Scholar Shared decision-making is a collaborative process that enables healthcare decisions to be made between patients and/or families and clinicians, with consideration of patient values and preferences, while also using the best available scientific evidence to make recommendations. [2] Kon A.A. Davidson J.E. Morrison W. Danis M. White D.B. Shared decision making in ICUs: an American College of critical care medicine and American thoracic society policy statement. Crit Care Med. 2016; 44 (Epub 2015/10/29; PubMed PMID: 26509317; PubMed Central PMCID: PMCPmc4788386): 188-201https://doi.org/10.1097/ccm.0000000000001396 Crossref PubMed Scopus (0) Google Scholar This collaborative process is recommended by critical care societies [3] Fried T.R. Communication about treatment options and shared decision making in the intensive care unit. JAMA Intern Med. 2019; 179: 684-685https://doi.org/10.1001/jamainternmed.2019.0034 Crossref PubMed Scopus (4) Google Scholar and healthcare organisations internationally. 4 ACSQHC. Australian Commission on Safety and Quality in Health Care. Partnering with consumers standard (Action 2.5, 2.6, 2.7). Retrieved from: https://www.safetyandquality.gov.au/standards/nsqhs-standards/partnering-consumers-standard.2018. Google Scholar , 5 Flannery L. Ramjan L.M. Peters K. End-of-life decisions in the Intensive Care Unit (ICU) – exploring the experiences of ICU nurses and doctors – a critical literature review. Aust Crit Care. 2016; 29: 97-103https://doi.org/10.1016/j.aucc.2015.07.004 Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar , 6 WHO. World Health OrganistionPatient safety. https://www.who.int/patientsafety/en/Date: 2018 Google Scholar Patients in intensive care units (ICUs) are often incapacitated and unable to communicate their treatment preferences. In these instances, the patients' families and friends assume the role of surrogate decision-makers (surrogates). Often, these surrogates find themselves in family meetings with clinicians where they are faced with challenging decisions made even more complex by the uncertainty of patient prognoses. [1] Cai X. Robinson J. Muehlschlegel S. White D.B. Holloway R.G. Sheth K.N. et al. Patient preferences and surrogate decision making in neuroscience intensive care units. Neurocritical Care. 2015; 23 (Epub 2015/05/21; PubMed PMID: 25990137; PubMed Central PMCID: PMCPmc4816524): 131-141https://doi.org/10.1007/s12028-015-0149-2 Crossref PubMed Scopus (39) Google Scholar Scheunemann et al. [7] Scheunemann L.P. Ernecoff N.C. Buddadhumaruk P. Carson S.S. Hough C.L. Curtis J.R. et al. Clinician-family communication about patients' values and preferences in intensive care units. JAMA Intern Med. 2019; 179 (PubMed PMID: 136383893. Language: English. Entry Date: In Process. Revision Date: 20190612. Publication Type: journal article. Journal Subset: Biomedical): 676-684https://doi.org/10.1001/jamainternmed.2019.0027 Crossref PubMed Scopus (37) Google Scholar recently explored this important area in a study of 249 family conferences, analysing how patient values and preferences are elicited during family meetings and how these preferences are applied to shared decisions made between surrogates and clinicians. A critique of this article is presented in the following.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".