Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Senior Consultant Victoria Metaxa, King's College London, UK
- Second opponent: Professor Berge Solberg, NTNU - Norwegian University of Science and Technology
- Third member and chair of the evaluation committee: Associate Professor Kåre Moen, University of Oslo
Chair of the Defence
Professor Angelika Sorteberg, University of Oslo
Principal Supervisor
Professor Reidun Førde, University of Oslo
Summary
Whether to start, continue, limit or withdraw life-sustaining treatment in patients with severe traumatic brain injury is a medical and an ethical challenge neurointensive care physicians are faced with on a regular basis. The patients themselves are vulnerable and unable to participate in decision-making. Their families are in a demanding emotional situation. Prognostication early after injury is difficult and involves uncertainty. In this thesis we seek insights into decision-making processes. We conducted a retrospective study at Oslo University Hospital. We found that treatment limiting decisions are common and most decisions occur early after admission (Paper 1). In an interview study we asked neurosurgeons, intensive care physicians and rehabilitation physicians how they reason and act in the process of reaching the right decision for an individual patient and which strategies they use to deal with uncertainty. In Paper 2 we describe the first 72 hours after admission. In Paper 3 we describe how physicians deal with patients with long-term lack of neurological improvement. The physicians were focused on avoiding premature decisions and avoiding self-fulfilling prophecies. We identified three main strategies the physicians used to deal with doubt during the first 72 hours after admission; 1. to provide time-limited treatment trials, 2. to use the time needed to strengthen decisional ground, 3. to collaborate within the multidisciplinary team. A shared decision-making model with family involvement was generally not used, at least not in the early phases after injury. In relation to patients with long-term lack of improvement we identified interphysician variability with a divide between proactive strategies and wait-and-see strategies. We believe triggers for ethical discussions, involvement of families in decision-making and neuropalliative care all are areas that need more focus and future development.
Additional information
Contact the research support staff.