Clinicians’ perceptions of the appropriateness of neurocritical care for patients with spontaneous intracerebral haemorrhage (ICH): A Qualitative Study

Journal article


Mc Lernon, S, Werring, D and Terry, L (2020). Clinicians’ perceptions of the appropriateness of neurocritical care for patients with spontaneous intracerebral haemorrhage (ICH): A Qualitative Study. Neurocritical Care.
AuthorsMc Lernon, S, Werring, D and Terry, L
Abstract

Background and Objective: Clinicians working in intensive care frequently report perceptions of inappropriate care (PIC) situations. ICH is associated with high rates of mortality and morbidity. Prognosticating after ICH is complex and may be influenced by clinicians’ subjective impressions and biases, which may, in turn, influence decision-making regarding the level of care provided. The aim of this study was to qualitatively explore perceptions of neurocritical care in relation to the expected functional outcome for ICH patients.
Design: Qualitative study using semi-structured interviews with neurocritical care doctors and nurses
Setting: Neurocritical Care (NCC) department in a UK neuroscience tertiary referral centre
Subjects: 11 neurocritical care nurses, 5 consultant neurointensivists, 2 stroke physicians, 3 neurosurgeons Intervention: None
Measurements and main results: We conducted 21 semi-structured interviews and identified five key themes: 1) Prognostic uncertainty 2) Subjectivity of good versus poor outcome 3) Perceived Inappropriate Care (PIC) situations (including for frail elderly patients) 4) Challenging nature of decision-making 5) Clinician distress
Conclusions: Caring for severely affected ICH patients in need of neurocritical care is challenging, particularly with frail elderly patients. Awareness of the challenges could facilitate interventions to improve decision-making for this group of stroke patients and their families, as well as measures to reduce the distress on clinicians who care for this patient group. Our findings highlight the need for effective interdisciplinary shared decision-making involving the family, taking into account patients’ previously expressed values and preferences and incorporating these into bespoke care planning.

KeywordsIntracerebral Haemorrhage; Prognostic uncertainty; Neurocritical Care; Perceived Inappropriate Care; Distress; Doctors; Nurses
Year2020
JournalNeurocritical Care
PublisherSpringer
ISSN1541-6933
Publication process dates
Accepted30 Oct 2020
Deposited21 Nov 2020
Accepted author manuscript
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Open
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