Variations in reporting of nurse involvement in end-of-life practices in intensive care units worldwide (ETHICUS-2): A prospective observational study

Abstract

BackgroundICU Nurses are most frequently at the patient's bedside, providing care for both patients and family members. They perform an essential role and are involved in decision making. Despite this, research suggests that nurses have a limited role in the end-of-life decision-making process and are occasionally not involved. Objectiveexplore global ICU nurse involvement in end of life decisions based on physician's perceptions, sub analyses from ETHICUS-2 study. DesignThis is a secondary analysis of a prospective multinational, observational study of the ETHICUS-2 study. SettingEnd of life decision-making processes in ICU patients were studied during a 6-month period between Sept 1, 2015, and Sept 30, 2016, in 199 ICUs in 36 countries.Intervention- none. MethodsThe ETHICUS II study instrument contained 20 questions. This sub analysis addressed the four questions related to nurse involvement in end-of-life decision making: Who initiated the end-of-life discussion? Were withholding or withdrawing treatment discussed with nurses? Was a nurse involved in making the end-of-life decision? Was there agreement between physicians and nurses? These 4 questions are the basis for our analysis. Global regions were compared. ResultsPhysicians completed 91.8 % of the data entry. A statistically significant difference was found between regions, (p < 0.001) with Northern Europe and Australia/New Zealand having the most discussion with nurses and Latin America, Africa, Asia and North America the least. The percentages of end-of-life decisions in which nurses were involved ranged between 3 and 44 %. These differences were statistically significant. Agreement between physicians and nurses related to decisions resulted in a wide range of responses (27–86 %) (p < 0.001). There was a wide range of those who replied “not applicable” to the question of agreement between physicians and nurses on EOL decisions (0–41 %). ConclusionThere is large variability in nurse involvement in end-of-life decision making in the ICU. The most concerning findings were that in some regions, according to physicians, nurses were not involved in EOL decisions and did not initiate the decision-making process. There is a need to develop the collaboration between nurses and physicians. Nurses have valuable contributions for best possible patient-centered decisions and should be respected as important parts of the interdisciplinary team. Tweetable abstract•Wide global differences were found in nurse end of life decision involvement, with low involvement in North and South America and Africa and higher involvement in Europe and Australia/New Zealand