Clinicians' Perceptions of the Appropriateness of Neurocritical Care for Patients with Spontaneous Intracerebral Hemorrhage (ICH): A Qualitative Study.
Journal article
Mclernon, S., Werring, David and Terry, Louise (2020). Clinicians' Perceptions of the Appropriateness of Neurocritical Care for Patients with Spontaneous Intracerebral Hemorrhage (ICH): A Qualitative Study. Neurocritical Care. https://doi.org/10.1007/s12028-020-01145-5
| Authors | Mclernon, S., Werring, David and Terry, Louise |
|---|---|
| Abstract | Clinicians working in intensive care frequently report perceptions of inappropriate care (PIC) situations. Intracerebral haemorrhage (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. Qualitative study using semi-structured interviews with neurocritical care doctors and nurses. Neurocritical care (NCC) department in a UK neuroscience tertiary referral center. Eleven neurocritical care nurses, five consultant neurointensivists, two stroke physicians, three neurosurgeons. None. 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. 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. |
| Keywords | Distress; Doctors; Intracerebral hemorrhage (ICH); Neurocritical care (NCC); Nurses; Perceived inappropriate care (PIC); Prognostic uncertainty |
| Year | 2020 |
| Journal | Neurocritical Care |
| Publisher | Springer |
| ISSN | 1556-0961 |
| Digital Object Identifier (DOI) | https://doi.org/10.1007/s12028-020-01145-5 |
| Publication dates | |
| Online | 02 Dec 2020 |
| Publication process dates | |
| Deposited | 21 Nov 2020 |
| Accepted | 30 Oct 2020 |
| Publisher's version | License File Access Level Open |
| Accepted author manuscript | License File Access Level Controlled |
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Publisher's version
| McLernon2020_Article_CliniciansPerceptionsOfTheAppr.pdf | ||
| License: CC BY 4.0 | ||
| File access level: Open | ||
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