End-of-life decisions in Swedish ICUs

Svantesson, Mia; Sjökvist, Peter; Thorsén, Håkan

doi:10.1016/s0964-3397(03)00055-7

Cited by 23 publications

(9 citation statements)

References 44 publications

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“…“Wait and see” might be a term that physicians use to delineate a period of time to ensure that the withdrawal decision is correct [16, 26]. The process of defining a turning point where treatments are considered futile is ethically challenging [17, 19].…”

Section: Discussionmentioning

confidence: 99%

“…The family’s role is to communicate the patient’s preferences [7, 13]. However, according to Scandinavian studies, physicians consider limiting intensive care treatment to be a medical decision in which they are the principal arbiter [14–16], and this often occurs without including nurses [17, 18] or making ethical reflections explicit [16]. Moreover, some physicians are reluctant to discuss ICU goals and methods with relatives when the patient is incompetent [19].…”

Section: Introductionmentioning

confidence: 99%

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Family members’ experiences of “wait and see” as a communication strategy in end-of-life decisions

et al. 2011

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PurposeThe aim of this study is to examine family members’ experiences of end-of-life decision-making processes in Norwegian intensive care units (ICUs) to ascertain the degree to which they felt included in the decision-making process and whether they received necessary information. Were they asked about the patient’s preferences, and how did they view their role as family members in the decision-making process?MethodsA constructivist interpretive approach to the grounded theory method of qualitative research was employed with interviews of 27 bereaved family members of former ICU patients 3–12 months after the patient’s death.ResultsThe core finding is that relatives want a more active role in end-of-life decision-making in order to communicate the patient’s wishes. However, many consider their role to be unclear, and few study participants experienced shared decision-making. The clinician’s expression “wait and see” hides and delays the communication of honest and clear information. When physicians finally address their decision, there is no time for family participation. Our results also indicate that nurses should be more involved in family–physician communication.ConclusionsFamilies are uncertain whether or how they can participate in the decision-making process. They need unambiguous communication and honest information to be able to take part in the decision-making process. We suggest that clinicians in Norwegian ICUs need more training in the knowledge and skills of effective communication with families of dying patients.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-011-2253-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Family members’ experiences of “wait and see” as a communication strategy in end-of-life decisions

et al. 2011

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“…Several studies show that physicians experience ethical dilemmas concerning the withholding or withdrawing of life-sustaining treatments [12-14], especially in the case of patients with cognitive impairment that reduces their capacity to decide on their own good [12,13]. Withdrawal of treatment may be experienced as unethical as physicians have a responsibility and a duty to save life [14]. Holley et al [15] showed that physicians in nephrology in the United States feel they are insufficiently trained for end-of-life care.…”

Section: Introductionmentioning

confidence: 99%

Feeling trapped and being torn: Physicians' narratives about ethical dilemmas in hemodialysis care that evoke a troubled conscience

2011

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BackgroundThis study is part of a major study about difficulties in communicating ethical problems within and among professional groups working in hemodialysis care. Describing experiences of ethically difficult situations that induce a troubled conscience may raise consciousness about ethical problems and thereby open the way to further reflection.The aim of this study was to illuminate the meanings of being in ethically difficult situations that led to the burden of a troubled conscience, as narrated by physicians working in dialysis care.MethodA phenomenological hermeneutic method was used to analyze the transcribed narrative interviews with five physicians who had varying lengths of experience in nephrology.ResultsThe analysis shows that physicians working in hemodialysis care suffered from a troubled conscience when they felt torn by conflicting demands and trapped in irresolution. They faced ethical dilemmas where they were forced to make crucial decisions about life or death, or to prioritize when squeezed between time restraints and professional and personal demands. In these ethical dilemmas the physicians avoided arousing conflicts, were afraid of using their authority, were burdened by moral responsibility and felt devalued and questioned about their way of handling the situation. The findings point to another way of encountering ethical dilemmas, being guided by their conscience. This mean sharing the agony of deciding how to act, being brave enough to bring up the crucial problem, feeling certain that better ways of acting have not been overlooked, being respected and confirmed regarding decisions made.ConclusionThe meanings of being in ethically difficult situations that led to the burden of a troubled conscience in those working in hemodialysis care, indicate the importance of increasing the level of communication within and among various professional groups - to transform being burdened by a troubled conscience into using conscience as a guide - in situations where no way of solving the problem seems to be good.

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“…Here reframing the situation is critical. This process of reframing is guided by due consideration of contextual factors given the futility of prevailing treatment, the lack of alternative treatment options, the continued deterioration of the patient and the patient’s general poor prognosis [ 50 – 52 ]. Similarly, the physician may reframe the situation and acknowledge that it is also their duty to cease futile and potentially burdensome treatment to prevent suffering, avoid prolonging the dying phase or return the patient to the original disease trajectory after a trial of treatment [ 53 – 60 ].…”

Section: Discussionmentioning

confidence: 99%

The impact of caring for dying patients in intensive care units on a physician’s personhood: a systematic scoping review

Kuek

Ngiam

Kamal

et al. 2020

Philos Ethics Humanit Med

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Background Supporting physicians in Intensive Care Units (ICU)s as they face dying patients at unprecedented levels due to the COVID-19 pandemic is critical. Amidst a dearth of such data and guided by evidence that nurses in ICUs experience personal, professional and existential issues in similar conditions, a systematic scoping review (SSR) is proposed to evaluate prevailing accounts of physicians facing dying patients in ICUs through the lens of Personhood. Such data would enhance understanding and guide the provision of better support for ICU physicians. Methods An SSR adopts the Systematic Evidenced Based Approach (SEBA) to map prevailing accounts of caring for dying patients in ICUs. To enhance the transparency and reproducibility of this process, concurrent and independent use of tabulated summaries, thematic analysis and directed content analysis (Split Approach) is adopted. Results Eight thousand three hundred fifty-eight abstracts were reviewed from four databases, 474 full-text articles were evaluated, 58 articles were included, and the Split Approach revealed six categories/themes centered around the Innate, Individual, Relational and Societal Rings of Personhood, conflicts in providing end of life care and coping mechanisms employed. Conclusion This SSR suggests that caring for dying patients in ICU impacts how physicians view their personhood. To resolve conflicts within individual concepts of personhood, physicians use prioritization, reframing and rely on accessible, personalized support from colleagues to steer coping strategies. An adapted form of the Ring Theory of Personhood is proposed to direct timely personalized, appropriate and holistic support.

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End-of-life decisions in Swedish ICUs

Cited by 23 publications

References 44 publications

Family members’ experiences of “wait and see” as a communication strategy in end-of-life decisions

Family members’ experiences of “wait and see” as a communication strategy in end-of-life decisions

Feeling trapped and being torn: Physicians' narratives about ethical dilemmas in hemodialysis care that evoke a troubled conscience

The impact of caring for dying patients in intensive care units on a physician’s personhood: a systematic scoping review

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