CRITICAL Study
Research type
Research Study
Full title
Conflict Resolution in the Intensive Care Unit for Incapacitated Adults (CRITICAL): Anticipating, Avoiding and Addressing Disagreements in “Best Interests” Decision-Making
IRAS ID
282331
Contact name
Harleen Kaur Johal
Contact email
Sponsor organisation
University of Bristol
Duration of Study in the UK
3 years, 1 months, 1 days
Research summary
This research investigates the problems that arise when making decisions for adults in critical care, who lack capacity to make decisions for themselves (e.g. through loss of consciousness after head injury or sedation for invasive ventilation). Notably, disagreements can occur where there is contention between the healthcare team and the patient’s representatives over the “best interests” of the patient. The latter is the key basis for making decisions about, for and with incapacitated adults, as per the Mental Capacity Act 2005.
The term “disagreement” has intentionally been used to capture all forms of discord between healthcare professionals and patient representatives. Alternative terms, like “conflict” and “dispute”, are available, although these are subject to debate. One aim of this research is therefore to determine how and when disagreements are recognised by different parties, and to typologise the different types of disagreement that occur. Disagreements over whether life-sustaining treatment (e.g. artificial ventilation, continuous artificial nutrition and hydration, haemodialysis) for incapacitated adult patients should be continued, withdrawn or withheld, appear to be dominant in the existing literature around disagreements in ICU. There is, comparatively, limited qualitative research around how healthcare professionals and patient representatives manage disagreements, when they occur.
Using qualitative methods, this study aims to fill a research gap by considering the disagreements that occur between healthcare professionals and patients representatives in greater detail, with identification of methods through which disagreements have been successfully anticipated, avoided or addressed. The experiences of professionals, patients and their representatives must all be considered, to establish the validity of these methods and potentially highlight any helpful or unhelpful behaviours exhibited by the ICU team. This study is part of the larger, cross-disciplinary Wellcome Trust-funded Balancing Best Interests in Healthcare Ethics and Law (BABEL) project, led by Professor Richard Huxtable.
REC name
South Central - Oxford C Research Ethics Committee
REC reference
21/SC/0181
Date of REC Opinion
6 Sep 2021
REC opinion
Further Information Favourable Opinion