Abstract
RATIONALE:
Chronic critical illness (CCI) results in high patient morbidity and mortality and imposes substantial burdens on families as surrogate decision-makers. Prior research has predominantly focused on families’ decisional needs before tracheostomy in the ICU, despite CCI unfolding over weeks to months across multiple care transitions and settings.
OBJECTIVE:
To characterize families’ decision-making experiences and reflections along the continuum of CCI, across time and care transitions.
METHODS:
We conducted semi-structured interviews with family decision-makers of patients who received a tracheostomy for persistent respiratory failure after an acute illness, first within two weeks to six months after tracheostomy and again weeks to months later. We analyzed data using inductive and deductive analysis methods.
RESULTS:
We interviewed 23 family decision-makers of 19 patients and identified five themes. 1) Tracheostomy is most often presented as a “needed” procedure in the acute setting, leaving families with a sense of little choice and limited awareness of the broader, long-term care trajectory; 2) Several families felt pressured to make a certain decision or judged when their decision opposed the team’s recommendation, specifically if they perceived the recommendation as misaligned with the patient’s goals; 3) After tracheostomy, families accepted ongoing interventions to reach a post-acute facility, which represented hope for recovery; 4) After transitioning to a post-acute facility, families faced uncertainty about recovery expectations and made ongoing decisions focused on overcoming setbacks amidst the rollercoaster of CCI; 5) The passage of time with CCI made it increasingly difficult for families to remain physically and psychologically present, leading to a growing sense of passivity in decision-making and a loss of control over the patient’s journey.
CONCLUSIONS:
We found critical problems in communication and support throughout the continuum of CCI. While the framing of tracheostomy as a “need” with limited deliberation about long-term implications remains problematic, our findings emphasize that tracheostomy is only one of many decisions families face throughout CCI. Our data suggest shifting the focus from ICU-based ‘tracheostomy decision-making’ to longitudinal decisional support that extends across time and settings, enabling ongoing reassessment and decision-making based on the patient’s evolving trajectory.
Key words using MeSH: mechanical ventilation; respiratory failure; medical decision-making; decision-making, shared; family research; person-centered care
Descriptor number: 4.13 Ventilation, Non-Invasive, Long-Term, Weaning
Introduction:
As advances in critical care have significantly improved survival rates from acute illness, nearly 400,000 people in the United States now live with chronic critical illness (CCI).1,2 CCI is a syndrome characterized by persistent respiratory failure, neuromuscular weakness, brain dysfunction, frailty, and skin breakdown, unfolding over weeks to months often involving multiple care setting transitions.2
Patients receiving mechanical ventilation for at least 21 days are at highest risk of death and disability,3–6 and because many of these patients are incapacitated, they rely on family for complex decision-making and support. However, families bear significant physical, emotional, social, and financial burdens throughout the patient’s protracted illness journey without systematic preparation or support.7–10
Many clinicians recognize tracheostomy placement for persistent respiratory failure after acute illness serves as a conduit from acute illness to CCI; thus, much of the existing literature has focused on families’ decisional needs prior to tracheostomy.11–16 However, little is known about families’ ongoing experiences making decisions across time and settings in CCI. Thus, our study characterizes families’ decision-making experiences and reflections throughout the course of CCI, across care settings and over time.
Methods:
We chose a longitudinal qualitative description approach using two semi-structured interviews per participant over time for a deeper exploration of families’ complex experiences and reflections on decision-making in CCI—including both their initial discussions about tracheostomy and their perceptions on ongoing decision-making across CCI.17–20 The consolidated criteria for reporting qualitative research (COREQ) guided our reporting.21
Participant selection and setting
We recruited families of patients admitted to intensive care units (ICUs) at UPMC Presbyterian, UPMC Shadyside, and UPMC Mercy hospitals in Pittsburgh, PA. Families were eligible if they were adult family members of adult patients who received a tracheostomy in an ICU for persistent respiratory failure after an acute illness and were involved in the patient’s care, including decision-making. Families remained eligible if their family member received a tracheostomy at another hospital prior to UPMC admission. Family members were ineligible if the corresponding patient received an emergency tracheostomy or was a lung transplant recipient, as these groups represent distinct populations. Screening occurred through medical record review based on inclusion/exclusion criteria, with eligibility confirmed using a screening script. We used purposive sampling to ensure that at least 20% of families were of underrepresented groups, particularly rural residents and Black or multiracial individuals. Recognizing that decision-making often involves multiple individuals, we permitted the inclusion of different family members of the same patient if they were actively involved in decision-making and the patient’s care.
Data Collection
Following informed consent, families engaged in two one-hour-long, semi-structured, audio-recorded interviews by telephone or in person, based on participant preference, between January 2023 and September 2024. The first interview was scheduled two weeks to six months after tracheostomy placement to balance recent decision-making involvement with more extensive experience with CCI, including beyond the ICU. The second interview was scheduled weeks to months later, accommodating families’ timing preferences. All interviews were conducted by ACM, who is trained in qualitative research and a pulmonary and critical care physician and was not part of the patient’s regular care team. We continued recruitment until thematic saturation was achieved and at least 20% of families were of underrepresented groups, particularly rural residents and Black or multiracial individuals.
We developed interview guides based on an extensive literature review [Supplement 1 and 2]. The first interview focused on three topics: 1) experiences around decision-making for tracheostomy, 2) broader experiences with CCI up to the time of the interview, and 3) families’ preferred information, resources, and supports based on their experiences to date. The second interview aimed to capture families’ evolving reflections and lived experiences over time and across care settings including ICUs, long-term acute care hospitals (LTACHs), acute rehabilitation, skilled nursing facilities, and/or home. We pilot-tested interview guides with experts in critical care, long-term acute care, palliative medicine, qualitative research, and decision-making science, revising questions as necessary to improve clarity.
Participating family members also completed a survey collecting demographic information and data from validated scales, including numeracy (Subjective Numeracy Scale), health literacy (BRIEF), physician trust (Wake Forest Physician Trust Scale), and decisional regret (Decision Regret Scale).22–25 We extracted clinical data from the corresponding patient’s current hospital stay, including etiology of persistent respiratory failure, and illness severity during UPMC ICU admission. All interviews were transcribed verbatim and de-identified. Participants received compensation. This study was approved by the University of Pittsburgh Institutional Review Board (STUDY22060144).
Data Analysis
We used deductive and inductive methods for our qualitative thematic analysis.26 To contextualize our findings within existing literature on decision-making before tracheostomy, we used deductive methods based on the “default” stages of shared decision-making (SDM)—information exchange, deliberation, and making a decision.27 However, recognizing that this framework may not fully capture families’ experiences with ongoing decision-making over time, we relied on inductive methods to uncover new patterns and concepts.26,28 Following Crabtree and Miller’s template organizing style,28 we followed a six-step analytical procedure: 1) ACM and CEK (medical trainee) developed an initial codebook template based on the interview guide, anticipated participant responses stemming from the research teams’ clinical and research experience with individuals with CCI, and the three stages of SDM for pre-tracheostomy decision-making experiences; 2) As interviews were completed and transcripts produced, ACM and CEK, serving as primary and secondary coders, independently coded transcripts using the initial codebook template. Coders also inductively added new codes for emerging topics and concepts. Coders then met to compare codes, iteratively refining the codebook and applying refined codes to prior transcripts. The codebook was finalized when no new codes emerged; 3) ACM and CEK double coded 16 transcripts (~41%), with consensus on interpretation and application of codes. ACM coded remaining transcripts; 4) Coded transcripts were then analyzed to identify patterns, categories, and themes; 5) All themes and associated quotes were reviewed and discussed with the larger study team for analyst triangulation, leveraging their topical and methodological expertise; and 6) Themes were disseminated to research participants for corroboration. We used NVivo 12 (Lumivero) for qualitative data management.
Results:
We analyzed a total of 39 interviews (22 initial interviews and 17 follow-ups) with 23 family decision-makers of 19 patients who received a tracheostomy for persistent respiratory failure. Family member characteristics, along with the corresponding patient characteristics, are shown in Table 1. Table 2 includes median days since tracheostomy, patient location, and patient status at the time of interviews. The median interval between interviews was 71 days (IQR, 53–152), with the initial interview occurring 26 days (IQR, 15–38) and the follow-up interview occurring 114 days (IQR, 85–173) after tracheostomy.
Table 1.
Family member and corresponding patient characteristics
| Family decision-maker (n= 23) | Patient (n=19) | |
|---|---|---|
| Age, median (IQR), y | 51 (43–58) | 61 (55–72) |
| Gender, n (%) | ||
| Female | 13 (56.5) | 9 (47.4) |
| Male | 10 (43.5) | 10 (52.6) |
| Race, n (%) a | ||
| Black | 4 (20) | 5 (26.3) |
| White | 15 (75) | 14 (73.7) |
| Multi-racial | 1 (5) | |
| Relationship to patient, n (%) | ||
| Adult Child | 11 (47.8) | |
| Spouse or partner | 9 (39.1) | |
| Sibling | 3 (13.1) | |
| Highest level of education, n (%) b | ||
| High school or less | 8 (38.1) | |
| Some college | 7 (33.3) | |
| 4-year degree or more | 6 (28.6) | |
| Geographic area of residence, n (%) b,c | ||
| Urban | 15 (71.4) | 12 (63.2) |
| Rural | 6 (28.6) | 7 (36.8) |
| BRIEF Literacy Screening, n (%) b,d | ||
| Limited | 1 (4.7) | |
| Marginal | 3 (14.3) | |
| Adequate | 17 (81.0) | |
| Wake Forest Physician Trust Scale, median (IQR) b,e | 40 (35–48) | |
| Subjective Numeracy Scale, median (IQR) b,f | 36 (33–43) | |
| Decision Regret Scale, median (IQR) b,g | 10 (0–20) | |
| Etiology of prolonged respiratory failure, n (%) | ||
| Acute on chronic respiratory failure | 8 (42.1) | |
| Encephalopathy | ||
| Hypoxic-Ischemia | 3 (15.8) | |
| Encephalitis | 1 (5.3) | |
| Toxic-Metabolic | 1 (5.3) | |
| Leptomeningeal carcinomatosis | 1 (5.3) | |
| Traumatic brain injury | 1 (5.3) | |
| Pneumonia | 4 (21.1) | |
| Cardiogenic pulmonary edema | 3 (15.8) | |
| Pulmonary Embolism | 1 (5.3) | |
| Admitting Intensive Care Unit, n (%) | ||
| Medical | 9 (47.4) | |
| Surgical | 10 (52.6) | |
| APACHE II score, mean (SD) h | 21.5 (5.3) | |
| Insurance, n (%) | ||
| Commercial | 3 (15.8) | |
| Medicare | 12 (63.2) | |
| Medicaid | 2 (10.5) | |
| Veterans Administration Health Care | 2 (10.5) |
missing data for 3 family members
missing data for 2 family members
based on zip code
BRIEF values range from a minimum of 4 to a maximum of 20, with 4–12 interpreted as limited, 13–26 as marginal and 17–20 as adequate health literacy.
Wake Forest Physician Trust Scale values range from 5–50, with higher scores indicating more trust.
Subjective Numeracy Scale values ranging from 8 to 48, with higher scores indicating higher subjective numeracy.
Decision Regret Scale values ranging 0 to 100, with 0 meaning no regret and 100 meaning high regret.
APACHE II score from first available data during ICU stay when tracheostomy was performed. Missing data for 2 family members
Table 2.
Median days since tracheostomy, patient location and patient status at time of interviews
| Interview 1 (N=22)a | Interview 2 (N=17)b | |
|---|---|---|
| Days since tracheostomy, median (IQR) | ||
| 26 (15–38) | 114 (85–173) | |
| Patient location at time of interview, n (%) | ||
| Floor | 7 (31.8) | 3 (17.6) |
| ICU | 10 (45.5) | 2 (11.8) |
| Long term acute care hospital | 5 (22.7) | 0 (0) |
| Inpatient rehabilitation | 0 (0) | 1 (5.9) |
| Skilled nursing facility | 0 (0) | 4 (23.5) |
| Home | 0 (0) | 5 (29.4) |
| Deceased | 0 (0) | 2 (11.8) |
| Status of 19 patients at time of interview, n (%) c | ||
| Alive | 19 (100) | 17 (89.5) |
| Deceased | 0 (0) | 2 (10.5) |
2 patients had more than 1 more family member
5 family members lost to follow up or declined second interview
status of alive or deceased based on total N of 19 patients
While our deductive analysis focused on the three stages of SDM for pre-tracheostomy decision-making, our inductive analysis revealed that families perceived tracheostomy as one of many decisions made over time and provided rich insights into families’ experiences making decisions across the CCI continuum. Therefore, this manuscript details families’ decision-making experiences both pre-tracheostomy in the ICU and post-tracheostomy across care settings. We identified five themes related to families’ decision-making experiences throughout CCI: 1) Tracheostomy is most often presented as a “needed” procedure in the acute setting, leaving families with a sense of little choice and limited awareness of the broader, long-term care trajectory; 2) Several families felt pressured to make a certain decision or judged when their decision opposed the team’s recommendation, specifically if they perceived the recommendation as misaligned with the patient’s goals; 3) After tracheostomy, families accepted ongoing interventions to reach a post-acute facility, which represented hope for recovery; 4) After transitioning to a post-acute facility, families faced uncertainty about recovery expectations and made ongoing decisions focused on overcoming setbacks amidst the rollercoaster of CCI; 5) The passage of time with CCI made it increasingly difficult for families to remain physically and psychologically present, leading to a growing sense of passivity in decision-making and a loss of control over the patient’s journey.
Theme 1. Tracheostomy is most often presented as a “needed” procedure in the acute setting, leaving families with a sense of little choice and limited awareness of the broader, long-term care trajectory.
Nearly all families reported that tracheostomy was framed as a need and viewed it as a necessary procedure and default next step in the acute setting. “They just told us it was necessary. It was the natural progression of getting off the ventilator” (P1). “All of a sudden the team was saying we really needed to move to the trach…you know how the ICU works…there are a bunch of acute things” (P3). Most families did not perceive there to be any other options or see that the decision was theirs to make: “They didn’t give me any other options” (P16), and “They called and asked if they could do it…I have to trust their decision” (P4). When “options” were recalled, they were not described as viable alternatives or discussion emphasized how not proceeding with a tracheostomy would lead to death, without addressing or discussing the broader context. “We had to do [the tracheostomy] because you can only stay intubated for so long, so it was the safer option” (P22). “They had to take the breathing tube out because it would damage her vocal cords” (P5). “They made it a pretty stark choice, we can either let her die or not” (P3).
Because conversations mainly focused on the tracheostomy procedure itself, there was limited deliberation and understanding of the long-term implications. “Most of the conversation focused on the procedure—should we do it at bedside or would they need to do it surgically…We didn’t get any information like, ‘can you live at home with a tracheostomy’ or ‘what is the quality of life with a tracheostomy’” (P3). Moreover, given families’ unfamiliarity with CCI, families struggled to probe further and ask informed questions. “It was like things were in slow motion when they asked, ‘Are there any questions?’…I had no idea. The problem is that there were answers I should have had” (P13).
Lastly, though some families found prior conversations about the patient’s preferences and formal documentation, such as advance directives, helpful, without an understanding of the patient’s current condition and CCI, several families felt compelled to apply previously expressed wishes about intubation to both acute and prolonged ventilation (P10, P21).
Theme 2. Several families felt pressured to make a certain decision or judged when their decision opposed the team’s recommendation, specifically if they perceived the recommendation as misaligned with the patient’s goals.
Several family members felt pressured to make a certain decision. One shared, “I didn’t want him to suffer anymore. I asked if there were ways for him to go comfortably, but they weren’t giving me that choice” (P2). Others felt pushed toward comfort care, with one family member sharing, “They just kept pushing palliative care” (P8). Likewise, several families felt judged when their final choice did not align with the care team’s recommendation. “We were just trying to follow what we thought was right. [You] shouldn’t feel condemned if you decide [on tracheostomy] or like people are trying to persuade you the other way” (P10). Notably, these families attributed their feelings of being pressured or judged to perceiving the team’s recommendation as misaligned with the values and goals they had expressed, leaving them feeling unheard and undervalued.
Theme 3. After tracheostomy, families accepted ongoing interventions to reach a post-acute facility, which represented hope for recovery.
After tracheostomy, most families felt the procedure had gone smoothly with few complications and were focused on transitioning from the ICU to a post-acute facility as a critical step toward recovery. “We just want to get to either [an LTACH] or [SNF] so badly because they say she’ll get [more] rehab” (P1). Even when patients faced ongoing challenges and recovery was unlikely, many families remained hopeful and focused on resolving acute issues to reach that next step. “I know that he doesn’t want to be on life support for the rest of his life, but today they just confirmed that he’s going to [an LTACH]…so as far as I know, he seems to be recovering” (P13). “We’re treading water right now…[but] I was very focused on getting her to [an LTACH]…she needed to get a shot to see if she could get off [the ventilator]” (P3).
Theme 4. After transitioning to a post-acute facility, families faced uncertainty about recovery expectations and made ongoing decisions focused on overcoming setbacks amidst the rollercoaster of CCI.
While arrival to a post-acute facility signified the opportunity for recovery, families were often uncertain about the what level of recovery to expect and the timeline in which recovery might occur, and sought clarity on potential next steps. “It would be good to know what threshold she needs to pass, if she is going to get there, and what it means if she doesn’t” (P3). Only one family member anticipated that additional decisions would need to be made based on their family member’s progress.
In contrast, most families described subsequent decisions as focused on managing acute challenges amidst the complex and protracted journey of CCI, which families described as a rollercoaster of “peaks” and “valleys” (Table 3). As one family member relayed, “We didn’t expect her to go back to the ICU two more times. It’s an emotional rollercoaster really” (P1). “Peaks” represented positive milestones, such as weaning and decannulation, and improvements in speech, swallowing, and/or physical function, as well as returning home or to a facility close to family, all of which renewed their sense of hope. Conversely, “valleys” often aligned with challenges typical of CCI—wounds, infections, encephalopathy, neuromuscular weakness, and recurrent or ongoing respiratory failure—which contributed to heightened uncertainty, distress, grief, and burden. During setbacks, families agreed to procedures and interventions aimed at overcoming acute challenges.
Table 3.
Family identified positive milestones and challenges along chronic critical illness
| Positive milestones | |
|---|---|
| Transition from the ICU to a post-acute care facility | |
| Weaning and decannulation | |
| Improved speech, swallowing, and/or mobility | |
| Returning home or to a facility near family | |
| Challenges | |
| Patient related | Family and system related |
| Neuromuscular weakness | Balancing responsibilities |
| Encephalopathy | Financial strain |
| Speech and swallow dysfunction | Long distance |
| Wounds | Transportation |
| Infections | Access to disability or sick leave |
| Recurrent and/or persistent respiratory failure | Burnout and psychological distress |
| Acute care facility readmission | |
| Placement challenges |
Theme 5. The passage of time with CCI made it increasingly difficult for families to remain physically and psychologically present, leading to a growing sense of passivity in decision-making and a loss of control over the patient’s journey.
The duration of the patient’s CCI significantly impacted families. “Everything’s taking longer than we thought” (P1). Many described taking time off work and putting their personal responsibilities aside to focus on their family member during their acute illness. However, maintaining this level of involvement became increasingly challenging over time due to financial strain, expiration of leave or disability coverage, and other competing responsibilities. “I am a temporary worker, so I was worried about potentially losing my job…my attention is divided” (P13). “With the finances being pretty strapped, it was hard to keep going down [to the hospital] because we’re so far away” (P6). In addition to the difficulties of being physically present, psychological distress compounded over time, with families expressing feelings of detachment and loss of control or influence in the situation. “I’m kind of numb to what’s going on. I don’t want to seem like I don’t care because I really do, but after a while you just get numb to it…this has been a slow, slow process and I’ve basically gotten hardened to it” (P4). Likewise, another family member shared, “This is just the path he’s on” (P11).
Discussion:
We found pervasive communication and support breakdowns across time and settings in CCI, with families facing numerous decisions over time, yet discussions with clinicians narrowly focused on immediate concerns rather than the patient’s long-term trajectory and priorities. Framing tracheostomy as a “needed” procedure with little deliberation left families unprepared for its long-term implications and ongoing decision-making based on the patient’s goal, priorities, and progress. Likewise, subsequent decisions regarding treatments, procedures, and interventions, felt nearly automatic and focused on overcoming acute issues. Over time, families became increasingly disconnected from decision-making and the patient’s outcome, feeling like passive passengers on CCI’s protracted rollercoaster of peaks and valleys. Our findings suggest that, just as CCI unfolds over weeks to months and across multiple settings, so too does decision-making, highlighting critical opportunities for ongoing decisional support and reassessment based on the patient’s evolving trajectory.
Our findings align with prior literature describing pre-tracheostomy decision-making, highlighting deficits in provider communication, poor prognostic concordance between surrogates and physicians, and families perceiving tracheostomy as the only option.11,12,13,15 29,30 Tracheostomy presented as a “need” was particularly salient in our study and this framing has important implications. As described by Kruser et al., presenting something as a “need” implies it is essential, making it the perceived default course of action without other options.31 Even if clinicians create space for discussion later, the initial framing of “need” can be challenging to overcome.31 Families also emphasized the emotional tension that arose when clinicians’ recommendations seemed misaligned with the patient’s goals and values. This reinforces the importance of ensuring families feel heard and understood, and that recommendations are clearly grounded in the patient’s goals and values.
Our study also extends prior knowledge by bridging families’ decision-making experiences before tracheostomy with those after tracheostomy and beyond the ICU. We found that tracheostomy decision-making is just one of many decisions families face across CCI, with major unaddressed communication and support problems across time and settings. Even with optimal communication in the ICU, uncertainty and clinical momentum—the near-automatic accumulation of ICU interventions driven by clinical norms and patterns, bypassing deliberation of patient preferences—can be difficult to penetrate and CCI will continue past the ICU.32–35 Our data suggest that there may be critical opportunities to reset communication, manage recovery expectations, and foster communal solidarity in active decision-making aligned with the patient’s values and preferences after tracheostomy and upon transition to post-acute settings.33,36 The ‘peaks’ identified by families may align with acceptable patient outcomes, while some of the ‘valleys’ may serve as meaningful markers of lack of improvement or deterioration, helping families and clinicians assess therapy response and inform subsequent decisions.36 Moreover, interrupting clinical momentum beyond the ICU may also improve family outcomes, as Wendlandt et al. found that patient readmission to an acute care hospital is negatively associated with the mental health of family decision-makers.37
Our study has several strengths and limitations. Our longitudinal design facilitated relationship building with family members and allowed us to gather a wide range of experiences and perspectives over time and across transitions, beyond our structured interview questions. By conducting interviews at varying intervals, we balanced the risk of recall bias with the advantage of capturing insights after extended time with CCI across settings, while also improving participant retention. Yet, families’ reflections may have continued to evolve with even longer follow-up. Additionally, patient mortality by the time of the second interview (median 114 days post-tracheostomy) in our cohort was lower compared to existing literature.1,2,38 However, the representation of surviving patients’ families offered a comprehensive understanding of families’ ongoing, real-time experiences over time, rather than just retrospective reflections on their experiences and the patient’s care. Considering that 18.2% of families were lost to follow-up for the second interview, it is possible the patients of these families had worse outcomes and that their perspectives may have differed. Lastly, while our study included patients and families from three different UPMC hospitals, as well as those who received tracheostomies at other hospitals prior to admission to UPMC, transferability of our findings may still be limited. Our study only included English-speaking individuals, and the economic diversity was lower than expected, as evidenced by the low number of patients with Medicaid. Moreover, although we did not identify theme divergence by self-identified race, but such differences could emerge with greater representation of different racial and ethnic populations.
Conclusion:
While enhanced decisional support pre-tracheostomy in the ICU remains essential, our findings advocate for shifting the focus from solely ‘tracheostomy decision-making’ to providing longitudinal decisional support throughout the course of CCI, across time and settings, with ongoing reassessment based on the patient’s evolving trajectory. Further research should specify and prioritize families’ multi-faceted needs for optimal decision-making across CCI, as well as improve understanding of barriers to longitudinal decisional support across different care settings.
Supplementary Material
Sources of Funding:
T32 HL 007563 (ACM)
K24 HL 148314-01 (DBW)
P01 HL 114453 (BJM)
Disclosures:
BJM has received personal consulting fees from Boehringer Ingelheim, BioAegis, and Synairgen Research, Ltd, and research funding from Genentech, Inc. The remaining authors declare no conflicts of interest. Artificial intelligence was only used for grammar/language improvements. All content was generated by the authors and is original.
Abbreviations:
- Chronic critical illness (CCI)
multi-organ failure syndrome, for which persistent respiratory failure and prolonged ventilator dependence are hallmarks.
- Intensive care unit (ICU)
a specialized unit designed to provide care to critically ill patients.
- Long-term acute care hospital (LTACH)
a specialty-care facility designed for patients with serious medical problems requiring ongoing intensive care, including prolonged invasive mechanical ventilation.
- Shared decision-making (SDM)
collaborative process that allows patients, or their surrogates, and clinicians to make health care decisions together, considering the best scientific evidence available, as well as the patient’s values, goals, and preferences.
- Skilled nursing facility (SNF)
a facility that provides short- or long-term skilled nursing care, with some having the capacity to provide chronic ventilator care.
Footnotes
Artificial Intelligence Disclaimer: Artificial intelligence was only used for grammar/language improvements. All content was generated by the authors and is original.
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