Background: We applied tracheostomy shared decision-making program for respiratory care center prolonged mechanical ventilation patients. The purpose of this study is to help patients and family members to have an understanding of both the methods of tracheostomy and endotracheal tube. We can then compare the prognostic differences between patients in the program who receive tracheostomy and who continue to maintain endotracheal tube.
Methods: A retrospective cross-sectional study was conducted. The study was performed at the respiratory care center of Dalin Tzu chi hospital from January 2017 to December 2019. We set up a tracheostomy decision-making program. The medical team identified eligible patients. We conduct semi-structured interviews to individual family members. We tracked the survival of each patient and confirmed the satisfaction of the patient or family members with taking part of the tracheostomy shared decision-making program in January 2020. Data of patients who participated in tracheostomy shared decision-making program were collected and analyzed.
Results: Fifty-seven respiratory care center patients attended the tracheostomy shared decision-making program. At the end of the study, 37 patients underwent tracheostomy (64.9%), and 20 patients maintained endotracheal tube intubation (35.1%). There was no significant difference in the factors of concern and the degree of concern regarding the methods of treatment in the two groups of patients. Patients or family members of the two groups have a good understanding of the two methods of treatment. The survival rate of patients undergoing tracheostomy was 86.5% and 86.5% of participants believed that they made an optimal decision based on the result of the tracheostomy shared decision-making program. The survival rate of patients who maintained endotracheal tube intubation was 40%, and the all of participants believed that they made an optimal decision based on the result of the tracheostomy shared decision-making program. Patients who underwent tracheostomy have a favorable survival rate.
Conclusions: The clinical application of tracheostomy shared decision-making program ensures that patients and family members have a clearer understanding of the methods of tracheostomy and endotracheal tube treatment. Overall, 91.2% of the participants believed that they made an optimal decision despite of the end result.