• Siobhan Mc Lernon, David Werring, and Louise Terry.
• School of Health and Social Care, London South Bank University, 103 Borough Road, London, SE1 OAA, UK. mclernt@lsbu.ac.uk.
• Neurocrit Care. 2021 Aug 1; 35 (1): 162171162-171.

Background And ObjectiveClinicians working in intensive care frequently report perceptions of inappropriate care (PIC) situations. Intracerebral haemorrhage (ICH) is associated with high rates of mortality and morbidity. Prognosticating after ICH is complex and may be influenced by clinicians' subjective impressions and biases, which may, in turn, influence decision making regarding the level of care provided. The aim of this study was to qualitatively explore perceptions of neurocritical care in relation to the expected functional outcome for ICH patients.DesignQualitative study using semi-structured interviews with neurocritical care doctors and nurses.SettingNeurocritical care (NCC) department in a UK neuroscience tertiary referral center.SubjectsEleven neurocritical care nurses, five consultant neurointensivists, two stroke physicians, three neurosurgeons.InterventionNone.Measurements And Main ResultsWe conducted 21 semi-structured interviews and identified five key themes: (1) prognostic uncertainty (2) subjectivity of good versus poor outcome (3) perceived inappropriate care (PIC) situations (including for frail elderly patients) (4) challenging nature of decision-making (5) clinician distress.ConclusionsCaring for severely affected ICH patients in need of neurocritical care is challenging, particularly with frail elderly patients. Awareness of the challenges could facilitate interventions to improve decision-making for this group of stroke patients and their families, as well as measures to reduce the distress on clinicians who care for this patient group. Our findings highlight the need for effective interdisciplinary shared decision making involving the family, taking into account patients' previously expressed values and preferences and incorporating these into bespoke care planning.© 2020. The Author(s).

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