Developing the Disorders of Consciousness Guideline and Challenges of Integrating Shared Decision-Making Into Clinical Practice

摘要

Objective: To review methodology informing evidence-based guideline development and integration of guidelines into clinical care through shared decision-making (SDM) and highlight challenges to SDM in disorders of consciousness. Methods: We describe guideline development strategies and implications for use, approaches to SDM generally and with surrogate decision makers, and considerations when implementing the prolonged disorders of consciousness guideline into clinical care. Results: Clinical practice guidelines aim to improve high-quality patient care and outcomes by assessing the best medical evidence and incorporating this into care recommendations. This is accomplished through transparent methodology and compliance with published standards. Guidelines support SDM with patients and surrogate decision makers. Effective SDM can be challenging in conditions such as prolonged disorders of consciousness where surrogates are required, but assessment of patient values and incorporation of these values into SDM is ethically critical. Conclusions: Recently published disorders of consciousness guideline recommendations provide strategies for clinicians to enhance quality care for individuals with prolonged disorders of consciousness. They also provide details helping clinicians partner with individuals with disorders of consciousness and their surrogates. Further research is needed into many aspects of caring for individuals with disorders of consciousness and optimal strategies for partnering with surrogates in decision-making.