![]() In the future, a mixed-methods research program could refine the conceptual model of clinical momentum, measure its impact on clinical practice, and interrupt its influence on unwanted care near the end of life.Ĭritical illness decision-making end of life care. We hypothesize that clinical momentum influences patients, families, and physicians to accept or tolerate ongoing interventions without consideration of likely outcomes, eventually leading to the delivery of unwanted care near the end of life. Existing models of medical decision-making in the ICU describe how individual signs, symptoms, or diagnoses automatically lead to intervention, bypassing opportunities to deliberate about the value of an intervention in the context of a patient's likely outcome or treatment preferences. The ICU is an environment that is generally permissive of intervention, and clinical practice norms and patterns of usual care can promote the accumulation of multiple interventions over time. The example of chronic critical illness illustrates how clinical momentum is generated and propagated during the care of patients with prolonged illness. We propose a novel term, "clinical momentum," to describe a system-level, latent, previously unrecognized property of clinical care that may contribute to the provision of unwanted care in the ICU. The si unit of momentum in physics is the product of units of mass and velocity. It is equal to 1,000 pounds-force and used primarily by American architects and engineers to measure engineering loads. A kip is a non-SI non-metric unit of force. However, most older adults report preferences to avoid this type of medical care and to prioritize comfort and quality of life near death. A kip-second (kips) is a unit of momentum in the US Customary Units and British Imperial Units. ![]() Many older adults in the United States receive invasive medical care near the end of life, often in an intensive care unit (ICU).
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