Exploring physician approaches to conflict resolution in end-of-life decisions in the adult intensive care unit: protocol for a systematic review of qualitative research

Harleen Kaur Johal*, Giles M Birchley, Richard Huxtable

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

1 Citation (Scopus)
54 Downloads (Pure)


Introduction Conflict is unfortunately well-documented in
the adult intensive care unit (AICU). In the context of end-oflife (EOL) decision-making (ie, the withdrawal or withholding
of life-sustaining treatment), conflict commonly occurs when
a consensus cannot be reached between the healthcare
team and the patient’s family on the ‘best interests’ of the
critically ill, incapacitated patient. While existing literature
has identified potential methods for conflict resolution, it is
less clear how these approaches are perceived and used by
stakeholders in the EOL decision-making process. We aim
to explore this by systematically reviewing and synthesising
the published evidence, which addresses the following
research question: what does existing qualitative research
reveal about physician approaches to addressing conflict
arising in EOL decisions in the AICU?
Methods and analysis Peer-reviewed qualitative
studies (retrieved from MEDLINE, Project Muse, Scopus,
EMBASE, Web of Science, PsycINFO, CINAHL, and LILACS)
examining conflict and dispute resolution in the context
of EOL decisions in the AICU setting will be included.
Two reviewers will independently screen either all or a
randomly selected sample of studies, with a third reviewer
independently screening studies of uncertain eligibility. The
‘thematic synthesis’ approach will be employed to analyse
the resulting data. The quality of included papers will be
assessed using the 2018 Mixed-Methods Assessment
Tool. The ‘Grading of Recommendations, Assessment,
Development, and Evaluations-Confidence in the Evidence
from Reviews of Qualitative research’ approach will be
used to assess our confidence in the findings.
Ethics and dissemination Ethical approval is not
required for this review, as only published data will
be included. We anticipate that the findings will be of
interest to healthcare professionals working in AICUs
and individuals working in bioethics, given the ethically
contentious nature of EOL decisions. The findings will be
disseminated at academic conferences and through openaccess publication in a peer-reviewed journal
Original languageEnglish
Article numbere057387
JournalBMJ Open
Issue number7
Publication statusPublished - 22 Jul 2022

Bibliographical note

Funding Information:
The work is based at the University of Bristol, as part of the ‘Balancing Best Interests in Health Care, Ethics and Law (BABEL)’ Collaborative Award. This research was funded in whole, or in part, by the Wellcome Trust Grant no. 209841/Z/17/Z. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.

Publisher Copyright:
© 2022 BMJ Publishing Group. All rights reserved.

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