dc.contributor.author | Robertsen, Annette | |
dc.contributor.author | Helseth, Eirik | |
dc.contributor.author | Laake, Jon H | |
dc.contributor.author | Førde, Reidun | |
dc.date.accessioned | 2019-09-03T05:29:06Z | |
dc.date.available | 2019-09-03T05:29:06Z | |
dc.date.issued | 2019 | |
dc.identifier.citation | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2019 Aug 28;27(1):81 | |
dc.identifier.uri | http://hdl.handle.net/10852/69851 | |
dc.description.abstract | Background
Multilevel uncertainty exists in the treatment of devastating brain injury and variation in end-of-life decision-making is a concern. Cognitive and emotional doubt linked to making challenging decisions have not received much attention. The aim of this study was to explore physicians´ doubt related to decisions to withhold or withdraw life-sustaining treatment within the first 72 h after devastating brain injury and to identify the strategies used to address doubt.
Method
Semi-structured interviews were conducted with 18 neurocritical care physicians in a Norwegian trauma centre (neurosurgeons, intensivists and rehabilitation specialists) followed by a qualitative thematic analysis.
Result
All physicians described feelings of doubt. The degree of doubt and how they dealt with it varied. Institutional culture, ethics climate and individual physicians´ values, experiences and emotions seemed to impact judgements and decisions. Common strategies applied by physicians across specialities when dealing with uncertainty and doubt were: 1. Provision of treatment trials 2. Using time as a coping strategy 3. Collegial counselling and interdisciplinary consensus seeking 4. Framing decisions as purely medical.
Conclusion
Decisions regarding life-sustaining treatment after devastating brain injury are crafted in a stepwise manner. Feelings of doubt are frequent and seem to be linked to the recognition of fallibility. Doubt can be seen as positive and can foster open-mindedness towards the view of others, which is one of the prerequisites for a good ethical climate. Doubt in this context tends to be mitigated by open interdisciplinary discussions acknowledging doubt as rational and a normal feature of complex decision-making. | |
dc.language.iso | eng | |
dc.rights | The Author(s); licensee BioMed Central Ltd. | |
dc.rights | Attribution 4.0 International | |
dc.rights.uri | http://creativecommons.org/licenses/by/4.0/ | |
dc.title | Neurocritical care physicians’ doubt about whether to withdraw life-sustaining treatment the first days after devastating brain injury: an interview study | |
dc.type | Journal article | |
dc.date.updated | 2019-09-03T05:29:06Z | |
dc.creator.author | Robertsen, Annette | |
dc.creator.author | Helseth, Eirik | |
dc.creator.author | Laake, Jon H | |
dc.creator.author | Førde, Reidun | |
dc.identifier.cristin | 1737595 | |
dc.identifier.doi | https://doi.org/10.1186/s13049-019-0648-9 | |
dc.identifier.urn | URN:NBN:no-72921 | |
dc.type.document | Tidsskriftartikkel | |
dc.type.peerreviewed | Peer reviewed | |
dc.identifier.fulltext | Fulltext https://www.duo.uio.no/bitstream/handle/10852/69851/1/13049_2019_Article_648.pdf | |
dc.type.version | PublishedVersion | |
cristin.articleid | 81 | |