ICU patients often die after poor communication and problematic decision making, receiving treatments incongruent with their wishes. Despite stress on the need to involve patients, families, and other care providers in limitation of treatment decision making, physicians often make these decisions with little input from others, guided by factors other than patient/family wishes. Patients are more likely to discuss end-of-life care with their families and prefer family members to make decisions. Nurses are seldom involved, a source of frustration to them with the potential to cause difficulty in care delivery. Patients, also seldom involved in ICU limitation decisions, report both fear of dying on life supports with no control and of being removed from life supports before they agree to that decision. The influence of social and cultural factors (e.g., age, race/ethnicity) has been identified as influential in provider/patient relations and in patient and provider choices about end of life, but little work has been conducted on these factors in limitation of care decision making in the ICU. Published guidelines for management of limitation of treatment decisions are based on expert opinion not on research data from clinical settings. This comprehensive review of the state of the science indicates that research is needed to understand multiple perspectives, how they differ and are similar, so that the decision-making process for patients, families, and providers may be improved. For example, work is needed to develop supports for early identification of patient preferences and implementation of those preferences, with guidelines based in empirical data.
Learning Objectives: 1. Articulate current research knowledge about end-of-life care in ICUs
Keywords: Death, 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.