| dc.description.abstract | Introduction: This study explored the experiences and processes undertaken by healthcare providers with regards to decision making for administering Life-Sustaining Treatment (LST) in Uganda. The specific objectives were: - To describe the experiences of healthcare providers in administering LST in the ICUs: To describe the process observed by healthcare providers in making decision on LST, and: To explore the factors influencing health care providers’ decision on withdrawing or withholding LST in the ICUs.
Methodology: This was a phenomenological study design, utilising qualitative methods of data collection and analysis. The study was conducted in the general ICUs of Mulago National Referral Hospital and Nakasero Hospital,–both located in Kampala, Uganda. Twenty In-depth interviews were conducted with purposively selected medical specialists who are directly involved in making decisions regarding provision of LST, including the surgeons, anaesthesiologist, paediatricians, physicians, and medical officers and nurses who work in the ICUs. Data was thematically analysed using NVivo software (release 1.0).
Results: Respondents explained that experiences in decision making for administering LST follows a thorough assessment of the patient’s condition, and engaging the patient’s family in decision making for the next course of action. But, some dilemmas tend to arise in the ICU where the intensivists and the patient’s family fail to reach a consensus on the treatment decision, as well as challenges in dealing with the patient’s advanced directives. Participants expressed that there is no standard process or steps that must be observed while deciding on LST, rather they often use international guidelines and try to fit them within the current settings. The factors influencing decisions to withdraw or withhold LST include; financial capacities of the patient’s family, resource capacity of the hospital, status of clinical examination, age of the patient, lack of improvement over time, fear of ending life, and fear of litigations.
Conclusion and recommendations: The study revealed that some of the experiences of the intensivists in the ICUs enhance recommended clinical ethical conduct such as engaging the patient’s family in a shared decision making with regards to LST. However, practical solutions are required to address the identified ethical dilemmas in both hospitals, especially the lack of standard functional processes that guide decision making for LST, financial triage in Nakasero hospital, inadequate human resource in Mulago hospital among others.
Some of the interfacing factors can be modified to improve the survival of ICU patients in Uganda, such as establishing well-structured and functional ethics committees, establishing treatment guidelines and protocols in ICUs, and encouraging Ugandans to subscribe for medical insurance while they are still in good health conditions to minimize on the financial triaging | en_US |
