title: Life support decision making in critical care: Identifying and appraising the qualitative research evidence.
abstract: OBJECTIVE
  The objective of this study is to identify and appraise qualitative research evidence on the experience of making life-support decisions in critical care.
  
  
  METHODS
  In six databases and supplementary sources, we sought original research published from January 1990 through June 2008 reporting qualitative empirical studies of the experience of life-support decision making in critical care settings.
  
  
  METHODS
  Fifty-three journal articles and monographs were included. Of these, 25 reported prospective studies and 28 reported retrospective studies.
  
  
  METHODS
  We abstracted methodologic characteristics relevant to the basic critical appraisal of qualitative research (prospective data collection, ethics approval, purposive sampling, iterative data collection and analysis, and any method to corroborate findings).
  
  
  RESULTS
  Qualitative research traditions represented include grounded theory (n = 15, 28%), ethnography or naturalistic methods (n = 15, 28%), phenomenology (n = 9, 17%), and other or unspecified approaches (n = 14, 26%). All 53 documents describe the research setting; 97% indicate purposive sampling of participants. Studies vary in their capture of multidisciplinary clinician and family perspectives. Thirty-one (58%) report research ethics board review. Only 49% report iterative data collection and analysis, and eight documents (15%) describe an analytically driven stopping point for data collection. Thirty-two documents (60%) indicated a method for corroborating findings.
  
  
  CONCLUSIONS
  Qualitative evidence often appears outside of clinical journals, with most research from the United States. Prospective, observation-based studies follow life-support decision making directly. These involve a variety of participants and yield important insights into interactions, communication, and dynamics. Retrospective, interview-based studies lack this direct engagement, but focus on the recollections of fewer types of participants (particularly patients and physicians), and typically address specific issues (communication and stress). Both designs can provide useful reflections for improving care. Given the diversity of qualitative research in critical care, room for improvement exists regarding both the quality and transparency of reported methodology.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. giacomin@mcmaster.ca
authors.forename: Mita
authors.initials: M
authors.lastname: Giacomini
authors.forename: Deborah
authors.initials: D
authors.lastname: Cook
authors.forename: Deirdre
authors.initials: D
authors.lastname: DeJean
mesh_terms: D003422:Critical Care; D003661:Decision Support Techniques; D006801:Humans; D008020:Life Support Care; D036301:Qualitative Research