Jansen Melanie, Moynihan Katie M, Taylor Lisa S, Basu Shreerupa
Clinical Ethics, Gold Coast Health, Gold Coast, QLD, Australia.
Department of Paediatric Intensive Care, Queensland Children's Hospital, Brisbane, QLD, Australia.
J Bioeth Inq. 2024 Oct 4. doi: 10.1007/s11673-024-10381-9.
Paediatric Intensive Care Units (PICU) are complex interdisciplinary environments where challenging, high stakes decisions are frequently encountered. We assert that appropriate decisions are more likely to be made if the decision-making process is comprehensive, reasoned, and grounded in thoughtful deliberation. Strategies to overcome barriers to high quality decision-making including, cognitive and implicit bias, group think, inadequate information gathering, and poor quality deliberation should be incorporated. Several general frameworks for decision-making exist, but specific guidance is scarce. In this paper, we provide specific guidance on collaborative complex decision-making for PICUs. The proposed approach is on principles of procedural justice and pragmatic hermeneutics. The process encompasses set-up/planning, information gathering, question formulation, analysis (perspectives, values, and principles), action plan development, decision documentation, and a review and appeal mechanism. The process can be adapted to suit other clinical contexts. Research evaluating the process, exploring how best to develop education for clinicians, and how to build a culture that values high quality deliberation, is worthwhile.
儿科重症监护病房（PICU）是复杂的跨学科环境，在此经常会遇到具有挑战性的高风险决策。我们认为，如果决策过程全面、合理且基于深思熟虑，那么更有可能做出恰当的决策。应纳入克服高质量决策障碍的策略，包括认知和隐性偏见、群体思维、信息收集不足以及审议质量不高。虽然存在几种通用的决策框架，但具体指导却很匮乏。在本文中，我们为PICU的协作式复杂决策提供具体指导。所提出的方法基于程序正义和实用诠释学原则。该过程包括设置/规划、信息收集、问题 formulation、分析（观点、价值观和原则）、行动计划制定、决策记录以及审查和上诉机制。该过程可进行调整以适用于其他临床环境。开展评估该过程、探索如何为临床医生提供最佳教育以及如何营造重视高质量审议的文化的研究是值得的。
