Ethical considerations in the prehospital treatment of out-of-hospital cardiac arrest: A multi-centre, qualitative study
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Ethical considerations in the prehospital treatment of out-of-hospital cardiac arrest : A multi-centre, qualitative study. / Milling, Louise; Nielsen, Dorthe Susanne; Kjær, Jeannett; Binderup, Lars Grassmé; de Muckadell, Caroline Schaffalitzky; Christensen, Helle Collatz; Christensen, Erika Frischknect; Lassen, Annmarie Touborg; Mikkelsen, Søren.
I: PLoS ONE, Bind 18, Nr. 7, e0284826, 2023.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Ethical considerations in the prehospital treatment of out-of-hospital cardiac arrest
T2 - A multi-centre, qualitative study
AU - Milling, Louise
AU - Nielsen, Dorthe Susanne
AU - Kjær, Jeannett
AU - Binderup, Lars Grassmé
AU - de Muckadell, Caroline Schaffalitzky
AU - Christensen, Helle Collatz
AU - Christensen, Erika Frischknect
AU - Lassen, Annmarie Touborg
AU - Mikkelsen, Søren
N1 - Publisher Copyright: © 2023 Milling et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2023
Y1 - 2023
N2 - Background Prehospital emergency physicians have to navigate complex decision-making in out-of-hospital cardiac arrest (OHCA) treatment that includes ethical considerations. This study explores Danish prehospital physicians’ experiences of ethical issues influencing their decision-making during OHCA. Methods We conducted a multisite ethnographic study. Through convenience sampling, we included 17 individual interviews with prehospital physicians and performed 22 structured observations on the actions of the prehospital personnel during OHCAs. We collected data during more than 800 observation hours in the Danish prehospital setting between December 2019 and April 2022. Data were analysed with thematic analysis. Results All physicians experienced ethical considerations that influenced their decision-making in a complex interrelated process. We identified three overarching themes in the ethical considerations: Expectations towards patient prognosis and expectations from relatives, bystanders, and colleagues involved in the cardiac arrest; the values and beliefs of the physician and values and beliefs of others involved in the cardiac arrest treatment; and dilemmas encountered in decision-making such as conflicting values. Conclusion This extensive qualitative study provides an in-depth look at aspects of ethical considerations in decision-making in prehospital resuscitation and found aspects of ethical decision-making that could be harmful to both physicians and patients, such as difficulties in handling advance directives and potential unequal outcomes of the decision-making. The results call for multifaceted interventions on a wider societal level with a focus on advance care planning, education of patients and relatives, and interventions towards prehospital clinicians for a better understanding and awareness of ethical aspects of decision-making.
AB - Background Prehospital emergency physicians have to navigate complex decision-making in out-of-hospital cardiac arrest (OHCA) treatment that includes ethical considerations. This study explores Danish prehospital physicians’ experiences of ethical issues influencing their decision-making during OHCA. Methods We conducted a multisite ethnographic study. Through convenience sampling, we included 17 individual interviews with prehospital physicians and performed 22 structured observations on the actions of the prehospital personnel during OHCAs. We collected data during more than 800 observation hours in the Danish prehospital setting between December 2019 and April 2022. Data were analysed with thematic analysis. Results All physicians experienced ethical considerations that influenced their decision-making in a complex interrelated process. We identified three overarching themes in the ethical considerations: Expectations towards patient prognosis and expectations from relatives, bystanders, and colleagues involved in the cardiac arrest; the values and beliefs of the physician and values and beliefs of others involved in the cardiac arrest treatment; and dilemmas encountered in decision-making such as conflicting values. Conclusion This extensive qualitative study provides an in-depth look at aspects of ethical considerations in decision-making in prehospital resuscitation and found aspects of ethical decision-making that could be harmful to both physicians and patients, such as difficulties in handling advance directives and potential unequal outcomes of the decision-making. The results call for multifaceted interventions on a wider societal level with a focus on advance care planning, education of patients and relatives, and interventions towards prehospital clinicians for a better understanding and awareness of ethical aspects of decision-making.
U2 - 10.1371/journal.pone.0284826
DO - 10.1371/journal.pone.0284826
M3 - Journal article
C2 - 37494384
AN - SCOPUS:85165894807
VL - 18
JO - PLoS ONE
JF - PLoS ONE
SN - 1932-6203
IS - 7
M1 - e0284826
ER -
ID: 368898621