Table 3 Recommendations for decision-making about limiting LST in very old patients
Problem | Recommendations |
|---|---|
Decision-making under uncertainty | Specify uncertainty (survival, functional outcome), explore potential to quantify uncertainty, establish multidisciplinary meetings and ethics ward rounds |
Uncertainty about short-term outcome | Develop framework for (time-limited) ICU trial [67] |
Uncertainty about potential for rehabilitation and long-term functional outcome | Consultations with geriatricians, treatment trial in rehabilitation according to the patient's phenotype [67,68,69] |
Uncertainty about burden of therapy and benefit of outcome for the individual patient | Communicate with next-of-kin, caregivers and primary care teams to elicit patient's values and preferences [70], monitor patient's comfort |
Knowledge gaps regarding survival and functional outcome in very old patients, absence of specific guidelines | Foster research and training based on international (multi-cultural) collaborations, seek advice from experts outside intensive care [45] |
Variations in values and preferences among patients and healthcare professionals | Develop sensitivity to cultural differences, seek mediation and legal advice in case of divergent opinions, support advanced care planning |