Complex Decision-Making in Paediatric Intensive Care: A Discussion Paper and Suggested Model.

IF 1.8 3区 哲学 Q2 ETHICS
Melanie Jansen, Katie M Moynihan, Lisa S Taylor, Shreerupa Basu
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引用次数: 0

Abstract

Paediatric Intensive Care Units (PICU) are complex interdisciplinary environments where challenging, high stakes decisions are frequently encountered. We assert that appropriate decisions are more likely to be made if the decision-making process is comprehensive, reasoned, and grounded in thoughtful deliberation. Strategies to overcome barriers to high quality decision-making including, cognitive and implicit bias, group think, inadequate information gathering, and poor quality deliberation should be incorporated. Several general frameworks for decision-making exist, but specific guidance is scarce. In this paper, we provide specific guidance on collaborative complex decision-making for PICUs. The proposed approach is on principles of procedural justice and pragmatic hermeneutics. The process encompasses set-up/planning, information gathering, question formulation, analysis (perspectives, values, and principles), action plan development, decision documentation, and a review and appeal mechanism. The process can be adapted to suit other clinical contexts. Research evaluating the process, exploring how best to develop education for clinicians, and how to build a culture that values high quality deliberation, is worthwhile.

儿科重症监护中的复杂决策:讨论文件和建议模式。
儿科重症监护室(PICU)是一个复杂的跨学科环境,在这里经常会遇到具有挑战性的高风险决策。我们认为,如果决策过程全面、合理,并以深思熟虑为基础,就更有可能做出适当的决策。应采取各种策略来克服阻碍高质量决策的障碍,包括认知和隐性偏见、群体思维、信息收集不足以及审议质量低下。目前已有几个通用的决策框架,但具体的指导却很少。在本文中,我们将为 PICU 的复杂决策协作提供具体指导。所建议的方法基于程序公正和实用诠释学的原则。该流程包括设置/规划、信息收集、问题提出、分析(观点、价值观和原则)、行动计划制定、决策记录以及审查和上诉机制。该流程可根据其他临床情况进行调整。对该流程进行评估、探索如何更好地开展临床医生教育以及如何建立重视高质量审议的文化,这些都值得研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Bioethical Inquiry
Journal of Bioethical Inquiry 医学-医学:伦理
CiteScore
5.20
自引率
8.30%
发文量
67
审稿时长
>12 weeks
期刊介绍: The JBI welcomes both reports of empirical research and articles that increase theoretical understanding of medicine and health care, the health professions and the biological sciences. The JBI is also open to critical reflections on medicine and conventional bioethics, the nature of health, illness and disability, the sources of ethics, the nature of ethical communities, and possible implications of new developments in science and technology for social and cultural life and human identity. We welcome contributions from perspectives that are less commonly published in existing journals in the field and reports of empirical research studies using both qualitative and quantitative methodologies. The JBI accepts contributions from authors working in or across disciplines including – but not limited to – the following: -philosophy- bioethics- economics- social theory- law- public health and epidemiology- anthropology- psychology- feminism- gay and lesbian studies- linguistics and discourse analysis- cultural studies- disability studies- history- literature and literary studies- environmental sciences- theology and religious studies
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