The conceptualisation of health-related quality of life in decision-making by intensive care physicians: A qualitative inquiry.
OBJECTIVE
To explore how intensive care physicians conceptualise and prioritise patient health-related quality of life in their decision-making.


METHODS
General qualitative inquiry using elements of Grounded Theory. Six ICU physicians participated.


METHODS
A large, closed, mixed ICU at a university-affiliated hospital, Australia.


RESULTS
Three themes emerged: (1) Multi-dimensionality of HRQoL-HRQoL was described as difficult to understand; the patient was viewed as the best informant. Proxy information on HRQoL and health preferences was used to direct clinical care, despite not always being trusted. (2) Prioritisation of HRQoL within decision-making-this varied across the patient's health care trajectory. Premorbid HRQoL was prioritised when making admission decisions and used to predict future HRQoL. (3) Role of physician in decision-making-the physicians described their role as representing society with peers influencing their decision-making. All participants considered their practice to be similar to their peers, referring to their practice as the "middle of the road". This is a novel finding, emphasising other important influences in high-stakes decision-making.


CONCLUSIONS
Critical care physicians conceptualised HRQoL as a multi-dimensional subjective construct. Patient (or proxy) voice was integral in establishing patient HRQoL and future health preferences. HRQoL was important in high stakes decision-making including initiating invasive and burdensome therapies or in redirecting therapeutic goals.
Department of Physiotherapy, Western Health, Furlong Road, St. Albans, Victoria 3021, Australia; Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, 200 Berkeley Street, Parkville 3010, Victoria, Australia. Electronic address: kimberley.haines@wh.org.au.
Dr Kimberley J
DKJ
Haines
Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, 200 Berkeley Street, Parkville 3010, Victoria, Australia.
Louisa
L
Remedios
Department of Physiotherapy, Austin Hospital, 145 Studley Road, Heidelberg 3084, Victoria, Australia.
Sue C
SC
Berney
Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg 3084, Victoria, Australia.
Dr Cameron
DC
Knott
Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, 200 Berkeley Street, Parkville 3010, Victoria, Australia.
Linda
L
Denehy
D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D003657:Decision Making; D066296:Grounded Theory; D006801:Humans; D007362:Intensive Care Units; D007407:Interviews as Topic; D010819:Physician's Role; D036301:Qualitative Research; D011788:Quality of Life
Decision-making; Grounded Theory; Intensive care; Quality of life