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UK consultants’ experiences of the decision-making process around referral to intensive care: an interview study
Örebro University, Sweden.
University of Warwick, UK.
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
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2021 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 3, article id e044752Article in journal (Refereed) Published
Sustainable development
SDG 3: Ensure healthy lives and promote well-being for all at all ages
Abstract [en]

Objective: The decision whether to initiate intensivecare for the critically ill patient involves ethical questions regarding what is good and right for the patient. It isnot clear how referring doctors negotiate these issuesin practice. The aim of this study was to describe and understand consultants’ experiences of the decision- making process around referral to intensive care.

Design: Qualitative interviews were analysed according to a phenomenological hermeneutical method.

Setting and participants: Consultant doctors (n=27) from departments regularly referring patients to intensive care in six UK hospitals.

Results: In the precarious and uncertain situation of critical illness, trust in the decision-making process is needed and can be enhanced through the way in which the process unfolds. When there are no obvious right or wrong answers as to what ought to be done, how the decision is made and how the process unfolds is morally important. Through acknowledging the burdensome doubts in the process, contributing to an emerging, joint understanding of the patient’s situation, and respondingto mutual moral duties of the doctors involved, trust in the decision-making process can be enhanced and a shared moral responsibility between the stake holding doctors can be assumed.

Conclusion: The findings highlight the importance of trust in the decision-making process and how the relationships between the stakeholding doctors are crucial to support their moral responsibility for the patient. Poor interpersonal relationships can damage trust and negatively impact decisions made on behalf of a critically ill patient. Forthis reason, active attempts must be made to foster good relationships between doctors. This is not only important to create a positive working environment, but a mechanism to improve patient outcomes.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2021. Vol. 11, no 3, article id e044752
Keywords [en]
Critical care, Clinical Decision-making, Clinical Ethics, Ethical Theory, Physicians
National Category
Medical Ethics
Research subject
Natural Science, Medicine
Identifiers
URN: urn:nbn:se:lnu:diva-101731DOI: 10.1136/bmjopen-2020-044752ISI: 000634886700021PubMedID: 33762241Scopus ID: 2-s2.0-85103265918Local ID: 2021OAI: oai:DiVA.org:lnu-101731DiVA, id: diva2:1539637
Available from: 2021-03-24 Created: 2021-03-24 Last updated: 2023-08-28Bibliographically approved

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Bremer, Anders

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