Evidence map›Paper›PMID 27217281›Full record

ArticleBMJ open2016

Factors influencing communication and decision-making about life-sustaining technology during serious illness: a qualitative study.

Jennifer Kryworuchko, P H Strachan, E Nouvet, J Downar, J J You

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In one paragraph

Article in BMJ open, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Jennifer KryworuchkoNursing and Centre for Health Services and Policy Research, University of British Columbia, and Research Scientist, British Columbia Centre for Palliative Care, Vancouver, British Columbia, Canada.
P H StrachanMcMaster University, Hamilton, Ontario, Canada.
E NouvetHumanitarian Health Care Ethics, McMaster University, Hamilton, Ontario, Canada.
J DownarDivisions of Critical Care and Palliative Care, University of Toronto and University Health Network, Toronto, Ontario, Canada.
J J YouDepartment of Medicine, Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.

Funding

CIHR MOP-11951
6 · The paper itself

Abstract

objectivesWe aimed to identify factors influencing communication and decision-making, and to learn how physicians and nurses view their roles in deciding about the use of life-sustaining technology for seriously ill hospitalised patients and their families.

designThe qualitative study used Flanagan's critical incident technique to guide interpretive description of open-ended in-depth individual interviews.

settingParticipants were recruited from the medical wards at 3 Canadian hospitals.

participantsInterviews were completed with 30 healthcare professionals (9 staff physicians, 9 residents and 12 nurses; aged 25-63 years; 73% female) involved in decisions about the care of seriously ill hospitalised patients and their families. MEASURES: Participants described encounters with patients and families in which communication and decision-making about life-sustaining technology went particularly well and unwell (ie, critical incidents). We further explored their roles, context and challenges. Analysis proceeded using constant comparative methods to form themes independently and with the interprofessional research team.

resultsWe identified several key factors that influenced communication and decision-making about life-sustaining technology. The overarching factor was how those involved in such communication and decision-making (healthcare providers, patients and families) conceptualised the goals of medical practice. Additional key factors related to how preferences and decision-making were shaped through relationships, particularly how people worked toward 'making sense of the situation', how physicians and nurses approached the inherent and systemic tensions in achieving consensus with families, and how physicians and nurses conducted professional work within teams. Participants described incidents in which these key factors interacted in dynamic and unpredictable ways to influence decision-making for any particular patient and family.

conclusionsA focus on more meaningful and productive dialogue with patients and families by (and between) each member of the healthcare team may improve decisions about life-sustaining technology. Work is needed to acknowledge and support the non-curative role of healthcare and build capacity for the interprofessional team to engage in effective decision-making discussions.

Indexed as

Clinical Decision-MakingCommunicationLife Support CareAdultAttitude of Health PersonnelCanadaCritical IllnessFemaleHumansMaleMiddle AgedPhysician-Patient RelationsProfessional RoleQualitative ResearchAdvanced IllnessAgingDecision-makingEnd-of-lifeHospitalPatient Involvement

Identifiers

PMID27217281
PMCPMC4885276

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.