Six years of a clinical communication intervention in shared decision-making to promote documentation of goals of care for critically ill patients with a life-limiting illness

IF 1.7 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation Pub Date : 2025-12-01 Epub Date: 2025-10-17 DOI:10.1016/j.ccrj.2025.100117

Georgia Peters BSc, MBBS (Hons), M Bioeth , Sharyn Milnes RN, GradCert CCN, GradCert Ed, GradDip AdEd, M Bioeth , Nicholas Simpson MBBS, FACEM, FCICM, PGDipEcho, GCHE , Olivia Gedye MBBS, FdnPallMed (cllinical) , Nima Kakho MBBS, FCICM , Charlie Corke MBBS, FCICM , Michael Bailey PhD, MSc, BSc (Hons) , Neil R. Orford MBBS, FCICM, FANZCA, PGDipEcho, PhD

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引用次数: 0

Abstract

Objective

Describe the association between the implementation of a shared decision-making (SDM) program and documentation of goals of care for critically ill patients with life-limiting illness (LLI).

Methods

A prospective longitudinal cohort study was conducted from 1st January 2015 to 30th September 2020 in an Australian tertiary teaching hospital. Adult patients with LLI admitted to the intensive care unit (ICU) were included. A SDM program consisting of communication training, a new goals of care form, and clinical support was implemented. The primary outcome was the proportion of patients with a documented SDM discussion. Secondary outcomes included patient treatment preferences and hospital utilisation parameters.

Results

A total of 1178 patients with LLI were admitted to the ICU during the study period and included in the study. Following the introduction of an SDM program, the proportion of patients with a documented SDM discussion increased from 22 % at baseline to a peak of 68 % at year five, then 60 % in year six of the study (adjusted odds ratio: 1.49, 95 % confidence interval: 1.38–1.60; p < 0.0001). Patients who had documented SDM were more likely to be older, female, frail, and have a prior advance care plan. SDM discussions resulted in higher rates of documented deterioration treatment preference plan (p < 0.0001), an increased ICU length of stay (3 vs. 2 days, p < 0.0001), referrals to palliative care services (p = 0.002), and a higher mortality rate. Time to death was significantly shorter in decedents with documented SDM compared to those without it (12 vs. 49 days, p < 0.0001).

Conclusion

The implementation of a comprehensive clinical communication training program was associated with increased documentation of shared decision-making discussions for patients in ICU with LLI, which corresponded with changes in patient treatment preferences and healthcare utilisation by decedents. Further research is required to understand the impact of these conversations from the perspective of patients and their families.

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六年的临床沟通干预，共同决策，以促进文件化的护理目标，危重患者的生命限制疾病

目的探讨共享决策（SDM）方案的实施与危重症限制性疾病（LLI）患者护理目标的记录之间的关系。方法于2015年1月1日至2020年9月30日在澳大利亚某三级教学医院进行前瞻性纵向队列研究。纳入重症监护病房（ICU）的成年LLI患者。实施了由沟通培训、新的护理形式目标和临床支持组成的SDM计划。主要结局是有记录的SDM讨论的患者比例。次要结局包括患者治疗偏好和医院利用参数。结果共1178例LLI患者在研究期间入住ICU并纳入研究。引入SDM计划后，记录SDM讨论的患者比例从基线时的22%增加到第五年的68%，然后在研究的第六年增加到60%（调整后的优势比：1.49,95%置信区间：1.38-1.60;p < 0.0001）。有记录的SDM患者更可能是老年人，女性，体弱，并且有事先的护理计划。SDM讨论导致记录的恶化率更高（p < 0.0001）， ICU住院时间增加（3天vs. 2天，p < 0.0001），转介到姑息治疗服务（p = 0.002），死亡率更高。记录在案的SDM患者的死亡时间明显短于无SDM患者（12天vs 49天，p < 0.0001）。结论全面的临床沟通培训计划的实施与ICU中LLI患者共同决策讨论的记录增加有关，这与患者治疗偏好和死者医疗保健利用的变化相对应。需要进一步的研究来从患者及其家属的角度理解这些对话的影响。

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来源期刊

Critical Care and Resuscitation CRITICAL CARE MEDICINE-

CiteScore

7.70

自引率

3.40%

发文量

审稿时长

>12 weeks

期刊介绍： ritical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines. The Journal is received by all Fellows and trainees, along with an increasing number of subscribers from around the world. The CC&R Journal currently has an impact factor of 3.3, placing it in 8th position in world critical care journals and in first position in the world outside the USA and Europe.