Voices from the ICU: A qualitative study of healthcare providers’ decision-making experiences during the provision of life-sustaining treatment in intensive care units of public and private referral hospitals in Uganda

Abstract

<title>Abstract</title> <bold>Introduction:</bold> The overall goal of intensive care treatment is to ensure patients return to an acceptable functional state, and, the decision-making in administering life-sustaining treatment (LST) is a key determinant of patients’ survival in intensive care units (ICUs). We explored the decision-making experiences and practices of healthcare providers (HCPs) regarding their use of LST in ICUs in Uganda. <bold>Methodology:</bold> This was a phenomenological study, conducted in ICUs of a public and private hospital in Uganda’s capital Kampala. Twenty in-depth interviews were conducted with purposively selected clinicians involved in making decisions regarding the provision of LST in both hospitals. Data were thematically analysed using NVivo software, series 1.0. <bold>Results:</bold> we found that, clinicians’ decision-making for administering LST followed a thorough assessment of the patient’s condition and engaged the patient’s family in the process. However, some dilemmas arose when the intensivists and the patient’s family disagreed on treatment decisions and in dealing with advanced directives. There were no standard guidelines followed while deciding on LST in the ICUs. The factors influencing decisions to withdraw or withhold LST included; financial capacity of the patient’s family, resource capacity of the hospital, status of clinical examination, patient’s age, response to treatment, and fear of litigations. <bold>Conclusion and recommendations:</bold> whereas some clinicians’ practices were based on internationally recommended clinical ethical conduct such as engaging the patient’s family in decision-making, the lack of national and/or institutional standard processes that guide decision-making remains a challenge. Establishing structured and functional clinical ethics committees, treatment guidelines or protocols could guide decision-making and improve the survival of patients in these ICUs.