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The complex decision-making process of referring patients to intensive care – meanings of senior doctor’s experiences
Örebro University, Sweden.
University of Warwick, UK.
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. (iCARE)ORCID iD: 0000-0001-7865-3480
University of Warwick, UK.
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2019 (English)In: Presented at the EACME Annual Conference 2019: Rethinking Ethics in 21st Century Europe, Oxford, UK, September 12-14, 2019, 2019Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Background: The decision whether to initiate intensive care for the critically ill patient involves ethical questions regarding what is good and right for the patient. It is not clear how referring doctors negotiate these ethical questions in practice.

Objectives: To illuminate the meaning of senior referring doctors´ lived experiences of decision-making about whether to initiate intensive care treatment. 

Methods: Analysis, using a phenomenological hermeneutical method, of interviews with 27 senior doctors from departments regularly referring patients to intensive care in six British hospitals. The interviews were conducted as part of the larger research project ‘Understanding and improving the decision-making process surrounding admission to the intensive care unit’, funded by the National Institute of Health Research, UK.

Results: Senior doctors struggle with the complex decision-making process when they are in doubt whether escalation to intensive care for the critically ill patient would be beneficial. A trusted process requires senior, mutual responsiveness between the referring doctor and the intensivist. Within the professional vulnerability created by the burdensome uncertainty of not being sure what is good and right for the patient, moral responsibility is secured through clinical proximity, and confidence is gained through responsive interaction.

Conclusions: Decision-making requires a reliable process based on mutual responsiveness and proximity. To promote this, an organizational structure and culture is needed where mutual recognition and support between decision-makers are valued.

Place, publisher, year, edition, pages
2019.
Keywords [en]
Decision-making, Intensive care, Senior doctors, Experiences
National Category
Medical Ethics
Research subject
Natural Science, Medicine
Identifiers
URN: urn:nbn:se:lnu:diva-89189OAI: oai:DiVA.org:lnu-89189DiVA, id: diva2:1352540
Conference
EACME Annual Conference 2019: Rethinking Ethics in 21st Century Europe, Oxford, UK, September 12-14, 2019
Available from: 2019-09-19 Created: 2019-09-19 Last updated: 2019-09-25Bibliographically approved

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Bremer, Anders

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CiteExportLink to record
Permanent link

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Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
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  • asciidoc
  • rtf