Dissertation Beatrix Goecking

Abstract

Treatment decisions in neurocritical care are challenging due to outcome uncertainties, time pressure, the altered consciousness levels of those affected, and overwhelmed surrogates. This dissertation aims to examine how the decision-making process in neurocritical care can be enhanced to better assist individuals in making decisions. To address this question, this dissertation examines the current state of
decision-making processes in neurocritical care and identifies strategies to enhance respect for autonomy at the organizational level.

The dissertation comprises five papers organized into three sections. The first section employs a qualitative research approach to examine health experiences after an aneurysmal subarachnoid hemorrhage. The second section employs a conceptual framework to present a preference-sensitive decision timeline, highlighting suitable moments for shared decision-making and advance care planning. Furthermore, this section encompasses the possible application of such timelines and illustrates their potential benefit. The third section addresses methodological challenges in inclusive
intensive care unit (ICU) research, with a focus on the challenge of operationalizing sex and gender in ICU research.

The main findings of this dissertation reveal blind spots in clinical decision-making as well as a need for structured guidance to enhance goal-concordant care and make informed decisions. The implementation of a preference-sensitive timeline can enhance structured guidance by improving transparency, identifying key decision points, and supporting all stakeholders throughout a dynamic disease trajectory.