Ethical conflicts are commonplace within intensive care units (ICUs). The primary source of ethical conflicts during critical illness pertain to the delivery of value-concordant care. Because most critically ill patients lack decisional capacity, critical care clinicians collaborate with the patient’s surrogate decision makers to determine the plan of care that best aligns with the patient’s preferences. However, this collaboration, known formally as shared decision-making, is difficult to execute. Surrogate decision makers may possess prognostic expectations that differ from those of critical care providers or may lack communication skills needed to advocate for the patient. As a result, patients often receive aggressive care inconsistent with their preferences, and surrogate decision makers experience persistent psychological distress.

Despite the negative clinical and psychological outcomes for critically ill patients and their surrogate decision makers, effective interventions that focus on reducing ethical conflicts during critical illness are lacking....

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