An integrative review of how families are prepared for, and supported during withdrawal of life‐sustaining treatment in intensive care

Coombs, Maureen; Parker, Roses; Ranse, Kristen; Endacott, Ruth; Bloomer, Melissa

doi:10.1111/jan.13097

Cited by 33 publications

(30 citation statements)

References 54 publications

(112 reference statements)

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“…Pressures on discussions about LST withdrawal may arise from patient prognosis, physician factors, nurse factors, concerns from patients' families, social factors, and economic factors [14]. During the decision-making process, listening to patients and their families with empathy, discussing time-limited treatments or trials, maintaining provision of comfort-oriented care for patients, supporting family members to meet their needs, and engaging in constant empathic communication may help [20,22,24]. One study that used a web-based survey of anesthesiologists' attitudes toward EOL issues in intensive care in Italy reported that 58% of discussions about LST withdrawal or withholding resulted in decisions, but that 70% of respondents' intensive care units did not have associative supportive or palliative care; a factor possibly related to physicians' and nurses' reluctance to discuss LST withdrawal [33].…”

Section: Discussionmentioning

confidence: 99%

“…Some research has focused on factors related to withdrawal of MV [4,19], and the perceptions [7] or satisfaction [18] of patients' families. In 2016, there were several studies on family preparation [20], communication [21,22], and support before and during LST withdrawal [20]. A descriptive study conducted in Korea, Japan, and China found that differences in the social status, moral values, religious beliefs, and economic status of each country were associated with physician attitudes toward LST withdrawal [23].…”

Section: Introductionmentioning

confidence: 99%

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Nurses’ Experiences and Factors Related to Their Attitudes Regarding Discussions with Patients and Family Members about Do-Not-Resuscitate Decisions and Life-Sustaining Treatment Withdrawal: A Hospital-Based Cross-Sectional Study

Chang

Lin

Chen

et al. 2020

IJERPH

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This study aimed to evaluate nurses’ experiences and factors related to their attitudes regarding discussions of do-not-resuscitate (DNR) and withdrawal of life-sustaining treatment (LST) with patients and their families. A cross-sectional survey was conducted in a tertiary hospital in Taiwan. Nurses aged ≥ 20 years who were in charge of acute inpatient care were randomly recruited. A semi-structured questionnaire was used to evaluate participants’ experiences and attitudes regarding discussions of DNR and LST withdrawal for terminal patients. Logistic regression with adjustment for covariates was used to analyze factors related to participants’ attitudes toward discussions about DNR and LST withdrawal with patients and families in the future care of terminal patients. The participants were 132 nurses. They had significantly more discussions about DNR and LST withdrawal with patients’ families than with patients. Regression analysis showed that participants who had past experiences in actively initiating DNR discussions with patients or patients’ families were significantly more likely to discuss DNR with patients in the future care of terminal patients, but participants aged 40.0 to 60.0 years were significantly less likely to have DNR discussions than those aged 20.0 to 29.9 years. Experiences of actively initiated DNR or LST discussions with patients’ families were significantly more likely to discuss DNR with patients’ families, but those aged 40.0 to 60.0 years were also significantly less likely to have DNR discussions than those aged 20.0 to 29.9 years. Experience in actively initiating discussions about LST withdrawal with patients’ families, being male, and possessing an education level higher than university were significantly related to LST withdrawal discussions with terminal patients or their families in the future. In conclusion, there need to be more discussions about DNR and LST withdrawal with patients. To protect patients’ autonomy and their rights to make decisions about their DNR and LST, measures are needed to facilitate DNR and LST discussions with patients to ensure better end-of-life care.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nurses’ Experiences and Factors Related to Their Attitudes Regarding Discussions with Patients and Family Members about Do-Not-Resuscitate Decisions and Life-Sustaining Treatment Withdrawal: A Hospital-Based Cross-Sectional Study

Chang

Lin

Chen

et al. 2020

IJERPH

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“…This reflects research showing that helping families to recognize a patient's deterioration is an integral part of the process when shifting to palliative care. 30…”

Section: Breaking Perceptions Of Normalizationmentioning

confidence: 99%

At the end: A vignette-based investigation of strategies for managing end-of-life decisions in the intensive care unit

Reader

Dayal

Brett

2020

Journal of the Intensive Care Society

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Background Decision-making on end-of-life is an inevitable, yet highly complex, aspect of intensive care decision-making. End-of-life decisions can be challenging both in terms of clinical judgement and social interaction with families, and these two processes often become intertwined. This is especially apparent at times when clinicians are required to seek the views of surrogate decision makers (i.e., family members) when considering palliative care. Methods Using a vignette-based interview methodology, we explored how interactions with family members influence end-of-life decisions by intensive care unit clinicians ( n = 24), and identified strategies for reaching consensus with families during this highly emotional phase of care. Results We found that the enactment of end-of-life decisions were reported as being affected by a form of loss aversion, whereby concerns over the consequences of not reaching a consensus with families weighed heavily in the minds of clinicians. Fear of conflict with families tended to arise from anticipated unrealistic family expectations of care, family normalization of patient incapacity, and belief systems that prohibit end-of-life decision-making. Conclusions To support decision makers in reaching consensus, various strategies for effective, coherent, and targeted communication (e.g., on patient deterioration and limits of clinical treatment) were suggested as ways to effectively consult with families on end-of-life decision-making.

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“…In other words, initial codes for results in each paper were identified through the extraction of themes from the 12 papers. Codes were drawn from the data without attempting to make them conform to pre‐existing sets of concepts, with patterns and relationships relevant to the review identified using an iterative process (Choi & Van Riper, ; Coombs, Parker, Ranse, Endacott, & Bloomer, ). These were then compared using an integrative process to identify commonalities, inconsistencies, and patterns; relationships between the initial codes were also identified.…”

Section: The Reviewmentioning

confidence: 99%

What are the beliefs and perceptions of practice nurses’ influence about the uptake of the measles, mumps, and rubella vaccine?: An integrative literature review

Hill

Salmon

Aitken

2018

Journal of Advanced Nursing

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An integrative review of how families are prepared for, and supported during withdrawal of life‐sustaining treatment in intensive care

Cited by 33 publications

References 54 publications

Nurses’ Experiences and Factors Related to Their Attitudes Regarding Discussions with Patients and Family Members about Do-Not-Resuscitate Decisions and Life-Sustaining Treatment Withdrawal: A Hospital-Based Cross-Sectional Study

Nurses’ Experiences and Factors Related to Their Attitudes Regarding Discussions with Patients and Family Members about Do-Not-Resuscitate Decisions and Life-Sustaining Treatment Withdrawal: A Hospital-Based Cross-Sectional Study

At the end: A vignette-based investigation of strategies for managing end-of-life decisions in the intensive care unit

What are the beliefs and perceptions of practice nurses’ influence about the uptake of the measles, mumps, and rubella vaccine?: An integrative literature review

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