Clinicians’ Perceptions of the Appropriateness of Neurocritical Care for Patients with Spontaneous Intracerebral Hemorrhage (ICH): A Qualitative Study

作者：Siobhan Mc Lernon, David J. Werring, Louise Terry · 发表于：Neurocritical Care · 年份：2020 · DOI：10.1007/s12028-020-01145-5 · 被引用次数：9 · 研究领域：Intracerebral and Subarachnoid Hemorrhage Research、Palliative Care and End-of-Life Issues、Sepsis Diagnosis and Treatment

BACKGROUND AND OBJECTIVE: 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. DESIGN: Qualitative study using semi-structured interviews with neurocritical care doctors and nurses. SETTING: Neurocritical care (NCC) department in a UK neuroscience tertiary referral center. SUBJECTS: Eleven neurocritical care nurses, five consultant neurointensivists, two stroke physicians, three 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 ...