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Interprofessional Shared Decision-Making in the ICU

A Systematic Review and Recommendations From an Expert Panel

Michalsen, Andrej MD, MPH1; Long, Ann C. MD, MS2,3; DeKeyser Ganz, Freda PhD, RN4; White, Douglas B. MD, MAS5; Jensen, Hanne I. PhD, RN6,7; Metaxa, Victoria MD, PhD8; Hartog, Christiane S. MD, PhD9,10; Latour, Jos M. PhD, RN11; Truog, Robert D. MD12; Kesecioglu, Jozef MD, PhD13; Mahn, Anna R. RN10; Curtis, J. Randall MD, MPH2,3

doi: 10.1097/CCM.0000000000003870
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Objectives: There is growing recognition that high-quality care for patients and families in the ICU requires exemplary interprofessional collaboration and communication. One important aspect is how the ICU team makes complex decisions. However, no recommendations have been published on interprofessional shared decision-making. The aim of this project is to use systematic review and normative analysis by experts to examine existing evidence regarding interprofessional shared decision-making, describe its principles and provide ICU clinicians with recommendations regarding its implementation.

Data Sources: We conducted a systematic review using MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases and used normative analyses to formulate recommendations regarding interprofessional shared decision-making.

Study Selection: Three authors screened titles and abstracts in duplicate.

Data Synthesis: Four papers assessing the effect of interprofessional shared decision-making on quality of care were identified, suggesting that interprofessional shared decision-making is associated with improved processes and outcomes. Five recommendations, largely based on expert opinion, were developed: 1) interprofessional shared decision-making is a collaborative process among clinicians that allows for shared decisions regarding important treatment questions; 2) clinicians should consider engaging in interprofessional shared decision-making to promote the most appropriate and balanced decisions; 3) clinicians and hospitals should implement strategies to foster an ICU climate oriented toward interprofessional shared decision-making; 4) clinicians implementing interprofessional shared decision-making should consider incorporating a structured approach; and 5) further studies are needed to evaluate and improve the quality of interprofessional shared decision-making in ICUs.

Conclusions: Clinicians should consider an interprofessional shared decision-making model that allows for the exchange of information, deliberation, and joint attainment of important treatment decisions.

1Department of Anaesthesiology and Critical Care, Medizin Campus Bodensee – Tettnang Hospital, Tettnang, Germany.

2Harborview Medical Center, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA.

3Cambia Palliative Care Center of Excellence, Harborview Medical Center, Department of Medicine, University of Washington, Seattle, WA.

4Hadassah Hebrew University School of Nursing, Jerusalem, Israel.

5Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.

6Departments of Anaesthesiology and Intensive Care, Lillebaelt Hospital, Vejle, Denmark.

7Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.

8Department of Critical Care, King’s College Hospital NHS Foundation Trust, London, United Kingdom.

9Patient- and Family-Centered Care, Klinik Bavaria Kreischa, Kreischa, Germany.

10Department of Anesthesiology and Operative Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.

11School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, United Kingdom.

12Center for Bioethics, Harvard, Medical School, as well as Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA.

13Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.

Drs. Michalsen, Ganz, White, Jensen, Metaxa, Latour, Truog, and Curtis conceptualized the article. Drs. Michalsen, Long, and Ganz reviewed the literature. All authors drafted and revised the article for important intellectual content as well as final approval for the version submitted.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. DeKeyser Ganz’s institution received funding from the Israel Institute of Health Policy Research, and she received funding from the Israel Higher Education Commission. Dr. Metaxa received funding from European Society of Intensive Care Medicine. Dr. Truog received funding from Covance (Data Safety Monitoring Committee) and Sanofi (Data Safety Monitoring Committees). Dr. Kesecioglu reports receiving honorarium from Xenios A.G. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Ethical standards: This research does not involve human participants or animals.

For information regarding this article, E-mail: jrc@u.washington.edu

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