Shared Decision-Making in the Neuro-ICU

Shared decision-making (SDM) is a process involving clinicians, patients, and surrogates that is grounded in making treatment decisions based on the best available scientific evidence and patient's values, goals, and preferences. This collaborative style of decision-making is urgently needed in the Neuro-ICU to meet the existing deficiencies in clinician-family communication and decision-making. SDM conceptual models include the Ottawa Decision Support Framework (ODSF) and Interprofessional Shared Decision-Making Model (IP-SDM) and form the basis of decision aids (DAs), which are SDM tools. The goal of SDM is to increase patient-value congruent decision-making, improve the quality of communication between clinicians and patient/surrogates, reduce decisional conflict and passivity, increase knowledge of decisions, and promote realistic expectations of treatments and outcomes. Further research is needed and currently underway to establish the efficacy of SDM in the Neuro-ICU on family, clinician, patient, and healthcare utilization outcomes.