Shared Decision Making in ICUs: An American College of Critical Care Medicine and American Thoracic Society Policy Statement.
OBJECTIVE
Shared decision making is endorsed by critical care organizations; however, there remains confusion about what shared decision making is, when it should be used, and approaches to promote partnerships in treatment decisions. The purpose of this statement is to define shared decision making, recommend when shared decision making should be used, identify the range of ethically acceptable decision-making models, and present important communication skills.


METHODS
The American College of Critical Care Medicine and American Thoracic Society Ethics Committees reviewed empirical research and normative analyses published in peer-reviewed journals to generate recommendations. Recommendations approved by consensus of the full Ethics Committees of American College of Critical Care Medicine and American Thoracic Society were included in the statement.


RESULTS
Six recommendations were endorsed: 1) DEFINITION: Shared decision making is a collaborative process that allows patients, or their surrogates, and clinicians to make healthcare decisions together, taking into account the best scientific evidence available, as well as the patient's values, goals, and preferences. 2) Clinicians should engage in a shared decision making process to define overall goals of care (including decisions regarding limiting or withdrawing life-prolonging interventions) and when making major treatment decisions that may be affected by personal values, goals, and preferences. 3) Clinicians should use as their "default" approach a shared decision making process that includes three main elements: information exchange, deliberation, and making a treatment decision. 4) A wide range of decision-making approaches are ethically supportable, including patient- or surrogate-directed and clinician-directed models. Clinicians should tailor the decision-making process based on the preferences of the patient or surrogate. 5) Clinicians should be trained in communication skills. 6) Research is needed to evaluate decision-making strategies.


CONCLUSIONS
Patient and surrogate preferences for decision-making roles regarding value-laden choices range from preferring to exercise significant authority to ceding such authority to providers. Clinicians should adapt the decision-making model to the needs and preferences of the patient or surrogate.
1Pediatric Critical Care Medicine, Naval Medical Center San Diego, San Diego, CA.2Department of Pediatrics, University of California San Diego School of Medicine, San Diego, CA.3University of California Health System, San Diego, CA.4Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA.5Department of Bioethics, National Institutes of Health, Bethesda, MD.6Program on Ethics and Decision Making in Critical Illness and Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Alexander A
AA
Kon
Judy E
JE
Davidson
Wynne
W
Morrison
Marion
M
Danis
Douglas B
DB
White
D000066491:Clinical Decision-Making; D003422:Critical Care / Q000592:standards*; D003657:Decision Making; D006801:Humans; D007362:Intensive Care Units; D014481:United States