Objectives: 1) To assess factors affecting stress of family members negotiating decisions to withdraw aggressive life-sustaining treatments from decisionally-incapacitated hospitalized patients; 2) To compare families' and clinicians' ethical reasoning. Family members often are surrogate decision makers for patients. Little research has established what factors influence family stress, nor has the ethical reasoning of families been compared to clinicians. Subjects included adult decedents (n=51) whose deaths followed withdrawal of treatment, family members (n=74), and clinicians (n=51). Family members were interviewed at 1- and 6-months following death. They completed the Horowitz Impact of Event Scale, the Rand Emotional/Mental Health Scale, the Reasoning Factor Rating Scales, and provided narrative information about what made the decision-making more or less stressful. Clinicians were interviewed at 1-month following death. They completed the Reasoning Factor Rating Scales and provided narrative information about negotiations with the family about the decision to withdraw. Family stress at 1-month was extremely high; three factors contributed: absence of advance directives, being a long distance from the hospital, and being ethnic minority. By 6-months, stress levels had decreased, and emotional/mental health had improved. Families and clinicians used different ethical reasoning; families prioritized medical feasibility (i.e., doing everything possible); clinicians prioritized patient autonomy. There needs to be better recognition about the extremely high level of family stress in the short term following negotiating decisions to forego life-sustaining treatments. Advance directives reduce family stress. Families and clinicians may use different priorities in deciding when to forego further life-sustaining treatments, with families
Learning Objectives: 1. Articulate factors that affect stress experienced by family members in withdrawal of life-sustaining treatments. 2.Compare families' and clinicians' ethical reasoning
Keywords: Elderly, Hospitals
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.