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Time-Limited Trials: a qualitative study exploring the role of time in decision-making on the Intensive Care Unit

Research output: Contribution to journalJournal article

E-pub ahead of print
<mark>Journal publication date</mark>10/11/2019
<mark>Journal</mark>Clinical Ethics
Number of pages6
Publication statusE-pub ahead of print
Early online date10/11/19
Original languageEnglish

Abstract

Background: Withholding and withdrawing treatment are deemed ethically equivalent by most Bioethicists, but intensivists often find withdrawing more difficult in practice. This can lead to futile treatment being prolonged. Time Limited Trials (TLTs) have been proposed as a way of promoting timely treatment withdrawal whilst giving the patient the greatest chance of recovery. Despite being in UK guidelines, TLTs have been infrequently implemented on Intensive Care Unit (ICU). We will explore the role of time in ICU decision-making and provide a UK perspective on debates surrounding TLTs.

Methods: This qualitative study recruited 18 participants (9 doctors, 9 nurses) from two ICUs in North West England for in-depth, one-to-one semi-structured interviews. A thematic analysis was performed of the data.

Results: Our findings show time is utilised by ICU staff in a variety of ways including managing uncertainty when making decisions about a patient’s prognosis or the reversibility of a disease; constructing relationships with patients’ relatives; communicating difficult messages to patients’ relatives; justifying resource allocation decisions to colleagues; and demonstrating compassion towards patients and their families.

Conclusions: Time shifts the balance towards greater certainty in ICU decision-making, by demonstrating futility, and can ease the difficult transition for staff and families from active treatment to palliation. However, this requires clear and open communication, both within the ICU team and with the family, being prioritised when time is used in decision-making.