Supplemental digital content to; A framework to support the process of decision-making on life- sustaining treatments in the intensive care unit: results of a Delphi study M.C. Kerckhoffs, MD Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands [email protected]Content - Methods section, detailed - Figure S1. The framework-draft presented in round one - Figure S2. Detailed results on handling of each element during the Delphi process - Table S1. Delphi expert panel, detailed characteristics - Table S2. Detailed description consensus process per round, including statistical reporting
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Supplemental digital content to;
A framework to support the process of decision-making on life-sustaining treatments in
the intensive care unit: results of a Delphi study
M.C. Kerckhoffs, MD
Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht
*Data missing for one intensivist participant. ICU Intensive Care Unit n/a non-applicable
ICU Admission meeting
Agreement Consensus per roundOne Two Three
Mean Equimedian IQRImportance 6.35 7 1Feasibility 5.48 6 2Items
Percentage agreementUpdate on current situation and disease/injury process
100%
Determine presence of pre-existing document patient preferences
89.75%
Clarify and determine current resuscitation status
94.25%
Identify and confirm surrogate decision-maker/legal representative
90.1%
Mean Equimedian IQRProvision of information regarding ICU
5.93 6 1 n/a
Treatment plan and interventions 6.17 6 1 n/aPotential outcomes and prognosis 5.93 7 2 n/aWho
Percentage agreementIntensivist 95.85%ICU nurse 96.15%ICU trainee Optional 67.8% X XReferring specialist Optional 61.5% X XTiming
Mean Equimedian IQRAs soon as achievable within 24h 6.55 7 1 X
Gathering of information on premorbid health and quality of life
Agreement Consensus per roundOne Two Three
Mean Equimedian IQRImportance 6.50 7 1Feasibility 5.53 6 2Items
Percentage agreementIndependence with activities of daily living 95.85%Mobility 90.3%Frailty 71.75%Cognition 89.8%Pain and discomfort on a daily basis 80.55%Anxiety and depression on a daily basis 75%Alcohol, drugs and smoking 72.7%
Mean Equimedian IQRReligion and cultural background 5.07 6 3 XApproach
Percentage agreementMeeting with intensivist, ICU nurse and family +/- patient
88.9% X
Mean Equimedian IQRMeeting to include update and discussion similar to admission meeting
5.78 6 1 n/a n/a
Additional approach/resourcesPercentage agreement
History from referring specialist 89.65% n/aMedical records 92.85% n/aBedside information 82.5% n/aValidated questionnaires 31.05% X X
Mean Equimedian IQRGeneral practitioner importance 5.49 6 3Other consultants known to patient: importance
5.03 6 2
TimingCombine with first family meeting on day 2 5.84 6 2 X X
Goals-of-care meeting
Agreement Consensus per roundOne Two Three
Mean Equimedian IQRImportance 6.37 7 1Feasibility 5.96 7 1Items
Percentage agreementUpdate on current status 97%Discuss treatment plan 81.75%Clarify goals of care plan 91.65%Identify milestones to indicate progress or failure
92%
Clarify limitations of treatment 100%Mean Equimedian IQR
Identification of family needs and requirement for support
5.75 6 2 n/a
Prognosis and expected outcomes 6.4 7 1 n/a n/aTiming
Percentage agreementPre-determined and at physician discretion
75.5%
Mean Equimedian IQRFrequency: minimum weekly 6.33 7 1Who