Patient involvement in health-related decisions during prolonged critical illness.
We describe patterns of communication of patients involved in health-related decision making during prolonged mechanical ventilation (PMV). Data were collected using observation, interview, and record review. Twelve of 30 patients participated in decisions about initiating, withdrawing, and withholding life-sustaining treatment, surgery, artificial feeding, financial/legal issues, discharge care, and daily care procedures. Patient involvement was largely validation or confirmation of what clinicians and families had already decided. Patients' participation was enlisted by clinicians and family members even when the patients did not exhibit full decisional capacity. Patient involvement in health-related decisions during prolonged critical illness is a shared and negotiated process that requires continued empirical study and ethical analysis.
Happ
Mary Beth
MB
School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA.
Swigart
Valerie A
VA
Tate
Judith A
JA
Hoffman
Leslie A
LA
Arnold
Robert M
RM
D000046:Academic Medical Centers; D000328:Adult; D016223:Advance Directives / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003142:Communication; D016638:Critical Illness / Q000523:psychology* / Q000628:therapy; D003657:Decision Making; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D008020:Life Support Care / Q000523:psychology; D008297:Male; D016743:Mental Competency; D008875:Middle Aged; D015404:Nursing Methodology Research; D010358:Patient Participation / Q000379:methods / Q000523:psychology; D011369:Professional-Patient Relations; D012121:Respiration, Artificial / Q000523:psychology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016312:Treatment Refusal / Q000523:psychology; D028761:Withholding Treatment