Aligning critical care interventions with patient goals: A modified Delphi study.
OBJECTIVE
To develop a list of non-emergent, potentially harmful interventions commonly performed in ICUs that require a clear understanding of patients' treatment goals.


BACKGROUND
A 2016 policy statement from the American Thoracic Society and American College of Critical Care Medicine calls on intensivists to engage in shared decision-making when "making major treatment decisions that may be affected by personal values, goals, and preferences."


METHODS
A three-round modified Delphi consensus process was conducted via a panel of 6 critical care physicians, 6 ICU nurses, 6 former ICU patients, and 6 family members from 6 academic and community-based medical institutions in the U.S. mid-Atlantic region.


RESULTS
Recommendations about 8 interventions achieved consensus among respondents.


CONCLUSIONS
Clinical and patient/family participants in a modified Delphi consensus process were able to identify preference-sensitive decisions that should trigger clinicians to clarify patient goals and consider initiating shared decision-making.
Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD, USA; Division of Pulmonary & Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA. Electronic address: turnbull@jhmi.edu.
Alison E
AE
Turnbull
Division of Pulmonary & Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Sarina K
SK
Sahetya
Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD, USA; Division of Pulmonary & Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Dale M
DM
Needham
D000328:Adult; D000368:Aged; D032921:Consensus; D003422:Critical Care / Q000592:standards*; D003657:Decision Making; D003697:Delphi Technique; D005190:Family; D005260:Female; D006040:Goals; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D008297:Male; D008875:Middle Aged; D010358:Patient Participation
Clinical decision-making; Critical care; Decision-making; Delphi technique; Life-sustaining treatments