Construcción de un protocolo de atención del paciente al final de la vida en la Unidad de Cuidados Intensivos. Consenso de expertos por metodología Delphi

Abstract

IntroductionThe biopsychosocial needs of the patient at the end-of-life demand active multidisciplinary assistance and are not limited to hospice care. The use of end-of-life order sets results in fewer treatment adjustments and greater involvement in spiritual care. ObjectiveTo build by consensus of experts using Delphi methods an end-of-life order set to use in intensive care settings. DesignConsensus study with Delphi methodology of mixed affected experts. The determination of dimensions, attributes and criteria was based on the review of the best available evidence. Convergence of the expert's opinions was obtained with relative interquartile range and agglutination of answers. SettingIntensive care units of a fourth level of care clinic in Bogotá, Colombia. ParticipantsIntensive medicine physicians with more than 3 years of experience in the care of the critically ill patient. InterventionsExpert competence coefficient assessment scale. Instrument with graded evidence for expert evaluation. Main variables of interestDegree of agreement with the recommendations, feasibility of implementation of interventions. ResultsSeven intensive care physicians participated as experts in this investigation. After two rounds, consensus was reached on the indications for the management of the patient at end-of-life stage. These indications were organized into 24 dimensions of care. ConclusionsThe Delphi methodology of affected experts is useful for the construction of instruments that support clinical practice, improving the quality of care and the use of available resources. The instrument resulting from this research must be validated in routine clinical practice.