‘I am old, and I will rather abandon life with my eyes open’: a qualitative study of Norwegians aged 80 and older explaining their intensive care unit admission preferences

BACKGROUND: The treatment preferences of patients aged 80 and older in the event of acute critical illness vary widely and are difficult to predict. To provide the appropriate level of care, it is necessary to better understand their personal treatment goals. OBJECTIVE: To gain insight into the underlying reasoning for intensive care unit (ICU) admission preferences in hypothetical events of acute critical illness stated by Norwegian survey respondents aged 80 and over. METHODS: A purposive sample of 202 Norwegian outpatients ≥80 years old who were considered potential ICU candidates provided 297 free-text comments to elaborate on their ICU admission choices in hypothetical scenarios of acute critical illness. Data were collected from November 2021 to March 2023 and analysed by Systematic Text Condensation, a method for thematic cross-case analysis. A theoretical framework for autonomy and trust in modern bioethics was utilized to focus the analysis. MAIN FINDINGS: All four main findings comprised descriptions of how the respondents sought to exercise autonomy. They explained their ICU admission preferences by (i) desiring to control the uncontrollable, (ii) prioritizing outcomes of importance to them, (iii) placing trust and (iv) accepting a larger context. We identified patterns ranging from the individual autonomy of varying degrees of action to the principled autonomy of obligation. Several justifications were relevant to different treatment choices. CONCLUSION: Despite variable expressions through different justifications, our findings highlight the need for a greater understanding of older patients' requirements for autonomy and a strong patient-centred focus in ICU admission decision-making.