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090 Decision timeline to aid shared decision-making post severe acute brain injury
  1. Beatrix Göcking1,
  2. Sophie Gloeckler1,
  3. Andrea Ferrario1,
  4. Giovanna Brandi2,
  5. Andrea Glässel3,
  6. Nikola Biller-Andorno1
  1. 1Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
  2. 2Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
  3. 3School of Health Science, Institute of Public Health, Zurich University of Applied Sciences, Winterthur, Switzerland

Abstract

Introduction Treatment decision-making following severe, acute brain injuries is challenging due to time pressure and patient lack of capacity. Strategies to support (proxy) shared decision-making are needed to increase the likelihood that patients receive care aligned with their treatment goals and values, especially given gender disparities and other biases present in acute care.

Methods The present research explores how preference-sensitive decision timelines might be useful to aid shared-decision making. In this conceptual approach, a sample preference-sensitive decision timeline1 was developed, taking aneurysmatic subarachnoid hemorrhage (aSAH) as a use case. The timeline was based on clinical expertise, existing guidelines, and insight from interviews with patients and loved ones affected by aSAH.

Results Following aSAH, six key decision moments can be isolated and described during the acute phase of disease: 1. Bleeding event, 2. Initial treatment decision, 3. Multimodal neuromonitoring, 4. Additional interventions based on new complications, 5 Long-term, life-sustaining surgical interventions such as tracheostomy, and 6. Care following discharge.

Discussion Clarifying these decisions moments may help stakeholders anticipate decisions to be made and prompt conversations about treatment to take place. The potential use of such timelines, though, introduces new questions regarding the complex dynamics involved in shared decision-making. To effectively incorporate such timelines into decision-making at the point of care, users’ needs and perspectives should be considered. When determining how best to develop and use such timelines, it is necessary to explore the potential challenges, risks, and additional preference-sensitive decisions post-discharge.

Conclusion Highlighting when patient or surrogate input is necessary can contribute valuably to shared decision-making, especially during the treatment process following severe acute brain injury. Such tools may refine shared decision-making so as to facilitate patients receiving their preferred care and reduce disparities between population groups.

Reference

  1. Göcking B, Gloeckler S, Ferrario A, Brandi G, Glässel A, Biller-Andorno NA case for preference-sensitive decision timelines to aid shared decision-making in intensive care: need and possible application. Front Digit Health 2023;5:1274717, 1–8.

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