Factors influencing multidisciplinary clinical decision-making in the critical care unit: a systematic review and mixed-methods meta-synthesis
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 internationall...
| 發表在: | BJA Open |
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| Main Authors: | , , , , , , |
| 格式: | Article |
| 語言: | 英语 |
| 出版: |
Elsevier
2025-12-01
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| 主題: | |
| 在線閱讀: | http://www.sciencedirect.com/science/article/pii/S2772609625001121 |
| _version_ | 1848774846658379776 |
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| author | Kenki Matsumoto Brigitta Fazzini Hannah Malcolm Jack Eldridge Zudin Puthucheary Magda Osman Timothy J. Stephens |
| author_facet | Kenki Matsumoto Brigitta Fazzini Hannah Malcolm Jack Eldridge Zudin Puthucheary Magda Osman Timothy J. Stephens |
| author_sort | Kenki Matsumoto |
| collection | DOAJ |
| container_title | BJA Open |
| 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). |
| format | Article |
| id | doaj-art-b48a12989a2f4792a4128c19382c7d49 |
| institution | Directory of Open Access Journals |
| issn | 2772-6096 |
| language | English |
| publishDate | 2025-12-01 |
| publisher | Elsevier |
| record_format | Article |
| spelling | doaj-art-b48a12989a2f4792a4128c19382c7d492025-09-27T05:08:40ZengElsevierBJA Open2772-60962025-12-011610048810.1016/j.bjao.2025.100488Factors influencing multidisciplinary clinical decision-making in the critical care unit: a systematic review and mixed-methods meta-synthesisKenki Matsumoto0Brigitta Fazzini1Hannah Malcolm2Jack Eldridge3Zudin Puthucheary4Magda Osman5Timothy J. Stephens6Adult Critical Care Unit (ACCU), The Royal London Hospital, Barts Health NHS Trust, London, UK; Critical Care and Perioperative Medicine Research Group, WHRI, Queen Mary University of London, London, UKAdult Critical Care Unit (ACCU), The Royal London Hospital, Barts Health NHS Trust, London, UK; Critical Care and Perioperative Medicine Research Group, WHRI, Queen Mary University of London, London, UK; Corresponding author.Adult Critical Care Unit (ACCU), The Royal London Hospital, Barts Health NHS Trust, London, UK; Critical Care and Perioperative Medicine Research Group, WHRI, Queen Mary University of London, London, UKAdult Critical Care Unit (ACCU), The Royal London Hospital, Barts Health NHS Trust, London, UK; Critical Care and Perioperative Medicine Research Group, WHRI, Queen Mary University of London, London, UKAdult Critical Care Unit (ACCU), The Royal London Hospital, Barts Health NHS Trust, London, UK; Critical Care and Perioperative Medicine Research Group, WHRI, Queen Mary University of London, London, UKCambridge Judge Business School, University of Cambridge, Cambridge, UKAdult Critical Care Unit (ACCU), The Royal London Hospital, Barts Health NHS Trust, London, UK; Critical Care and Perioperative Medicine Research Group, WHRI, Queen Mary University of London, London, UKBackground: 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).http://www.sciencedirect.com/science/article/pii/S2772609625001121complex decisionsdecision-makingdecision modelmultidisciplinaryorgan support |
| spellingShingle | Kenki Matsumoto Brigitta Fazzini Hannah Malcolm Jack Eldridge Zudin Puthucheary Magda Osman Timothy J. Stephens Factors influencing multidisciplinary clinical decision-making in the critical care unit: a systematic review and mixed-methods meta-synthesis complex decisions decision-making decision model multidisciplinary organ support |
| title | Factors influencing multidisciplinary clinical decision-making in the critical care unit: a systematic review and mixed-methods meta-synthesis |
| title_full | Factors influencing multidisciplinary clinical decision-making in the critical care unit: a systematic review and mixed-methods meta-synthesis |
| title_fullStr | Factors influencing multidisciplinary clinical decision-making in the critical care unit: a systematic review and mixed-methods meta-synthesis |
| title_full_unstemmed | Factors influencing multidisciplinary clinical decision-making in the critical care unit: a systematic review and mixed-methods meta-synthesis |
| title_short | Factors influencing multidisciplinary clinical decision-making in the critical care unit: a systematic review and mixed-methods meta-synthesis |
| title_sort | factors influencing multidisciplinary clinical decision making in the critical care unit a systematic review and mixed methods meta synthesis |
| topic | complex decisions decision-making decision model multidisciplinary organ support |
| url | http://www.sciencedirect.com/science/article/pii/S2772609625001121 |
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