Factors influencing communication and decision-making about life-sustaining technology during serious illness: a qualitative study

OBJECTIVES

We aimed to identify factors influencing communication and decision-making, and to learn how physicians and nurses view their roles in deciding about the use of life-sustaining technology for seriously ill hospitalised patients and their families.

DESIGN

The qualitative study used Flanagan's critical incident technique to guide interpretive description of open-ended in-depth individual interviews.

SETTING

Participants were recruited from the medical wards at 3 Canadian hospitals.

PARTICIPANTS

Interviews were completed with 30 healthcare professionals (9 staff physicians, 9 residents and 12 nurses; aged 25-63 years; 73% female) involved in decisions about the care of seriously ill hospitalised patients and their families.

MEASURES

Participants described encounters with patients and families in which communication and decision-making about life-sustaining technology went particularly well and unwell (ie, critical incidents). We further explored their roles, context and challenges. Analysis proceeded using constant comparative methods to form themes independently and with the interprofessional research team.

RESULTS

We identified several key factors that influenced communication and decision-making about life-sustaining technology. The overarching factor was how those involved in such communication and decision-making (healthcare providers, patients and families) conceptualised the goals of medical practice. Additional key factors related to how preferences and decision-making were shaped through relationships, particularly how people worked toward 'making sense of the situation', how physicians and nurses approached the inherent and systemic tensions in achieving consensus with families, and how physicians and nurses conducted professional work within teams. Participants described incidents in which these key factors interacted in dynamic and unpredictable ways to influence decision-making for any particular patient and family.

CONCLUSIONS

A focus on more meaningful and productive dialogue with patients and families by (and between) each member of the healthcare team may improve decisions about life-sustaining technology. Work is needed to acknowledge and support the non-curative role of healthcare and build capacity for the interprofessional team to engage in effective decision-making discussions.

Polymer-stabilized cholesteric liquid crystals as switchable photonic broad bandgaps

A cholesteric liquid crystal can be considered as a one-dimensional photonic crystal with a refractive index that is regularly modulated along the helix axis because of the particular arrangement of the molecules. The result is that the propagation of light is suppressed for a particular range of wavelengths (bandgap). A polymer-stabilized cholesteric liquid crystal (PSCLC), which is obtained by in situ photopolymerization of reactive liquid-crystal molecules in the presence of non-reactive liquid-crystal molecules in an oriented Bragg planar texture, is elaborated by combining the UV-curing with a thermally induced pitch variation. As a consequence, it is shown here that memory effects are introduced into the characteristics of the reflection band of the material at room temperature. In the visible spectrum, the reflection bandwidth can be tuned in agreement with the thermal ramp and broadened. In addition, the bandgap filters can be switched between broadband reflective, scattering and transparent states by subjecting them to an electric field. Related application fields of these functional materials are switchable smart windows for the control of the solar-light spectrum and white-or-black polarizer-free reflective displays.