| Title: |
Factors influencing multidisciplinary clinical decision-making in the critical care unit: a systematic review and mixed-methods meta-synthesis |
| Authors: |
Kenki Matsumoto; Brigitta Fazzini; Hannah Malcolm; Jack Eldridge; Zudin Puthucheary; Magda Osman; Timothy J. Stephens |
| Source: |
BJA Open, Vol 16, Iss , Pp 100488- (2025) |
| Publisher Information: |
Elsevier, 2025. |
| Publication Year: |
2025 |
| Collection: |
LCC:Anesthesiology |
| Subject Terms: |
complex decisions; decision-making; decision model; multidisciplinary; organ support; Anesthesiology; RD78.3-87.3 |
| Description: |
Background: The intensive care unit (ICU) is a dynamic environment that necessitates daily clinical decisions regarding organ support treatments. The decision-making process varies significantly between clinicians (i.e. doctors, nurses, and allied healthcare practitioners), even where internationally accepted treatment guidance exists. The factors and the processes influencing clinical decision-making are poorly understood. This systematic review aims to generate a decision-making model by evaluating current evidence on the decision-making process and the factors that affect decisions on organ support treatments in the ICU. Methods: We conducted a systematic search on three databases (PubMed, Embase, and CINAHL) including all papers exploring factors that influenced organ support decisions (PROSPERO: CRD42021283290). A mixed-methods meta-synthesis was performed to enable the generation of distinct themes and subthemes used to generate the decision-making model. Results: After screening 8967 records, 33 studies met the inclusion criteria and were included in the analysis. The mixed-method interpretation of the data found that decision-making can be linear and primarily dictated by patient factors (i.e. patient’s clinical parameters). However, the analysis identified 11 factors that can influence and strain clinician’s decision-making. Four themes: 1) human, 2) team, 3) system, and 4) patient emerged as the potential modifiable factors to optimise the decision-making process. Conclusions: Decision-making surrounding organ support treatment is complex and dynamic. However, there are four distinctive potentially modifiable themes that influence the multidisciplinary decision-making process. Further studies should focus on understanding interventions to improve decision-making and if different decision-making processes directly affect patients’ outcomes. Systematic review protocol: PROSPERO (CRD42021283290). |
| Document Type: |
article |
| File Description: |
electronic resource |
| Language: |
English |
| ISSN: |
2772-6096 |
| Relation: |
http://www.sciencedirect.com/science/article/pii/S2772609625001121; https://doaj.org/toc/2772-6096 |
| DOI: |
10.1016/j.bjao.2025.100488 |
| Access URL: |
https://doaj.org/article/b48a12989a2f4792a4128c19382c7d49 |
| Accession Number: |
edsdoj.b48a12989a2f4792a4128c19382c7d49 |
| Database: |
Directory of Open Access Journals |