Decision aids for life-sustaining treatment, including withholding or withdrawal and end-of-life care in emergency and intensive care settings: a scoping review protocol

Vollständiger Abstract

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Introduction Decisions regarding life-sustaining treatment and end-of-life care are among the most ethically complex and emotionally challenging decisions encountered in emergency departments and intensive care units. Such decisions frequently involve uncertainty regarding prognosis, limited time for deliberation and situations in which patients may lack decision-making capacity, requiring family members or surrogate decision-makers to participate in the decision-making process. Shared decision-making (SDM) has increasingly been recommended as an approach to align treatment decisions with patients’ values and preferences. Decision aids are evidence-based tools designed to support informed and value-congruent healthcare decisions by presenting available options, potential benefits and harms and opportunities for values clarification. Although decision aids have been extensively studied in chronic disease management and preference-sensitive healthcare decisions, their use in life-sustaining treatment and end-of-life care in emergency and intensive care settings remains fragmented and has not yet been comprehensively mapped. This scoping review aims to identify and map the existing literature on decision aids and related interventions that support SDM for life-sustaining treatment and end-of-life care in emergency and intensive care settings. Methods and analysis This scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Electronic searches will be performed in PubMed, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL and Ichushi-Web. Studies published in English or Japanese from January 2000 onwards will be eligible. Quantitative, qualitative, mixed-methods and descriptive studies addressing decision aids or related interventions designed to support SDM regarding life-sustaining treatment and end-of-life care among adult patients, family members, surrogate decision-makers or healthcare professionals in emergency and intensive care settings will be included. Two reviewers will independently screen studies, assess eligibility and chart data. Findings will be synthesised descriptively and presented in narrative and tabular formats. Ethics and dissemination Ethics approval is not required because this review will analyse data from publicly available literature and will not involve human participants. Findings will be disseminated through publication in a peer-reviewed journal and presentation at relevant scientific conferences.