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Title: The conceptualisation of health-related quality of life in decision-making by intensive care physicians: a qualitative inquiry
Austin Authors: Haines, Kimberley J ;Remedios, Louisa;Berney, Susan C ;Knott, Cameron I ;Denehy, Linda
Affiliation: Department of Physiotherapy, Western Health, St Albans, Victoria, Australia
Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
Department of Physiotherapy, Austin Health, Heidelberg, Victoria, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Issue Date: May-2017
Date: 2016-08-29
Publication information: Australian Critical Care 2017; 30(3): 152-159
Abstract: OBJECTIVES: To explore how intensive care physicians conceptualise and prioritise patient health-related quality of life in their decision-making. RESEARCH METHODOLOGY/DESIGN: General qualitative inquiry using elements of Grounded Theory. Six ICU physicians participated. SETTING: A large, closed, mixed ICU at a university-affiliated hospital, Australia. RESULTS: Three themes emerged: (1) Multi-dimensionality of HRQoL-HRQoL was described as difficult to understand; the patient was viewed as the best informant. Proxy information on HRQoL and health preferences was used to direct clinical care, despite not always being trusted. (2) Prioritisation of HRQoL within decision-making-this varied across the patient's health care trajectory. Premorbid HRQoL was prioritised when making admission decisions and used to predict future HRQoL. (3) Role of physician in decision-making-the physicians described their role as representing society with peers influencing their decision-making. All participants considered their practice to be similar to their peers, referring to their practice as the "middle of the road". This is a novel finding, emphasising other important influences in high-stakes decision-making. CONCLUSION: Critical care physicians conceptualised HRQoL as a multi-dimensional subjective construct. Patient (or proxy) voice was integral in establishing patient HRQoL and future health preferences. HRQoL was important in high stakes decision-making including initiating invasive and burdensome therapies or in redirecting therapeutic goals.
DOI: 10.1016/j.aucc.2016.08.004
Journal: Australian Critical Care
PubMed URL:
Type: Journal Article
Subjects: Decision-making
Grounded Theory
Intensive care
Quality of life
Appears in Collections:Journal articles

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