Value choices and considerations when limiting intensive care treatment: a qualitative study.
BACKGROUND
To shed light on the values and considerations that affect the decision-making processes and the decisions to limit intensive care treatment.


METHODS
Qualitative methodology with participant observation and in-depth interviews, with an emphasis on eliciting the underlying rationale of the clinicians' actions and choices when limiting treatment.


RESULTS
Informants perceived over-treatment in intensive care medicine as a dilemma. One explanation was that the decision-making base was somewhat uncertain, complex and difficult. The informants claimed that those responsible for taking decisions from the admitting ward prolonged futile treatment because they may bear guilt or responsibility for something that had gone wrong during the course of treatment. The assessments of the patient's situation made by physicians from the admitting ward were often more organ-oriented and the expectations were less realistic than those of clinicians in the intensive care unit who frequently had a more balanced and overall perspective. Aspects such as the personality and the speciality of those involved, the culture of the unit and the degree of interdisciplinary cooperation were important issues in the decision-making processes.


CONCLUSIONS
Under-communicated considerations jeopardise the principle of equal treatment. If intensive care patients are to be ensured equal treatment, strategies for interdisciplinary, transparent and appropriate decision-making processes must be developed in which open and hidden values are rendered visible, power structures disclosed, employees respected and the various perspectives of the treatment given their legitimate place.
Halvorsen
K
K
Faculty of Nursing Education, Akershus University College, Lillestrøm, Norway. kristin.halvorsen@medisin.uio.no
Førde
R
R
Nortvedt
P
P
D000328:Adult; D003422:Critical Care / Q000379:methods*; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses; D035501:Uncertainty