Respiratory support withdrawal in intensive care units: families, physicians and nurses views on two hypothetical clinical scenarios

Renata Rl Fumis,Daniel Deheinzelin

doi:10.1186/cc9390

Renata Rl Fumis, Daniel Deheinzelin

Open Access

https://doi.org/10.1186/cc9390

Copy DOI

Journal: Critical Care	Publication Date: Jan 1, 2010
Citations: 65	License type: cc-by

Affiliation: Hospital Sírio-Libanês, AC Camargo Hospital

Abstract

IntroductionEvidence suggests that dying patients' physical and emotional suffering is inadequately treated in intensive care units. Although there are recommendations regarding decisions to forgo life-sustaining therapy, deciding on withdrawal of life support is difficult, and it is also difficult to decide who should participate in this decision.MethodsWe distributed a self-administered questionnaire in 13 adult intensive care units (ICUs) assessing the attitudes of physicians and nurses regarding end-of-life decisions. Family members from a medical-surgical ICU in a tertiary cancer hospital were also invited to participate. Questions were related to two hypothetical clinical scenarios, one with a competent patient and the other with an incompetent patient, asking whether the ventilator treatment should be withdrawn and about who should make this decision.ResultsPhysicians (155) and nurses (204) of 12 ICUs agreed to take part in this study, along with 300 family members. The vast majority of families (78.6%), physicians (74.8%) and nurses (75%) want to discuss end-of-life decisions with competent patients. Most of the physicians and nurses desire family involvement in end-of-life decisions. Physicians are more likely to propose withdrawal of the ventilator with competent patients than with incompetent patients (74.8% × 60.7%, P = 0.028). When the patient was incompetent, physicians (34.8%) were significantly less prone than nurses (23.0%) and families (14.7%) to propose decisions regarding withdrawal of the ventilator support (P < 0.001).ConclusionsPhysicians, nurses and families recommended limiting life-support therapy with terminally ill patients and favored family participation. In decisions concerning an incompetent patient, physicians were more likely to maintain the therapy.

Highlights

Evidence suggests that dying patients’ physical and emotional suffering is inadequately treated in intensive care units
While sophisticated technological support has allowed intensive care units (ICUs) (Intensive Care Unit) patients to survive longer, there is a widespread perception that intensive medical care at the end of life frequently represents excessive, inappropriate use of technology [1,2]
We found that for patients with severe a prognosis and with metastasis, family members were more likely to decide for withdrawal of life support (Table 5)

Summary

Introduction

Evidence suggests that dying patients’ physical and emotional suffering is inadequately treated in intensive care units. There are recommendations regarding decisions to forgo life-sustaining therapy, deciding on withdrawal of life support is difficult, and it is difficult to decide who should participate in this decision. Throughout North America and Europe, between 40% and 90% of deaths in intensive care are preceded by the decision to withdraw or withhold life support [9]. Decisions to forgo life-sustaining therapy are commonly made worldwide and their frequency is increasing: in five years, the proportion of ICU deaths where such decisions were taken went from 51% to 90% [10]. Advanced care planning and effective ongoing communication among clinicians, patients and families are essential to improve end-of-life decision-making and reduce the frequency of a mechanically supported, painful and prolonged process of dying [11]. The participation of nursing staff in ethical decisions is recommended [6], the involvement of nurses was shown to vary from 16% (in a Canadian study) to almost 96% (in the USA) [2]

Objectives

Methods

Results

Discussion

Conclusion