Experiences and attitudes of medical professionals on treatment of end-of-life patients in intensive care units in the Republic of Croatia: a cross-sectional study

Abstract

Background Decisions about limitations of life sustaining treatments (LST) are made for end-of-life patients in intensive care units (ICUs). The aim of this research was to explore the professional and ethical attitudes and experiences of medical professionals on treatment of end-of-life patients in ICUs in the Republic of Croatia. Methods A cross-sectional study was conducted among physicians and nurses working in surgical, medical, neurological, and multidisciplinary ICUs in the total of 9 hospitals throughout Croatia using a questionnaire with closed and open type questions. Exploratory factor analysis was conducted to reduce data to a smaller set of summary variables. Mann–Whitney U test was used to analyse the differences between two groups and Kruskal–Wallis tests were used to analyse the differences between more than two groups. Results Less than third of participants (29.2%) stated they were included in the decision-making process, and physicians are much more included than nurses (p < 0.001). Sixty two percent of participants stated that the decision-making process took place between physicians. Eighteen percent of participants stated that ‘do-not-attempt cardiopulmonary resuscitations’ orders were frequently made in their ICUs. A decision to withdraw inotropes and antibiotics was frequently made as stated by 22.4% and 19.9% of participants, respectively. Withholding/withdrawing of LST were ethically acceptable to 64.2% of participants. Thirty seven percent of participants thought there was a significant difference between withholding and withdrawing LST from an ethical standpoint. Seventy-nine percent of participants stated that a verbal or written decision made by a capable patient should be respected. Physicians were more inclined to respect patient’s wishes then nurses with high school education (p = 0.038). Nurses were more included in the decision-making process in neurological than in surgical, medical, or multidisciplinary ICUs (p < 0.001, p = 0.005, p = 0.023 respectively). Male participants in comparison to female (p = 0.002), and physicians in comparison to nurses with high school and college education (p < 0.001) displayed more liberal attitudes about LST limitation. Conclusions DNACPR orders are not commonly made in Croatian ICUs, even though limitations of LST were found ethically acceptable by most of the participants. Attitudes of paternalistic and conservative nature were expected considering Croatia’s geographical location in Southern Europe.

The Complex Dynamics of Decision-Making at the End of Life in the Intensive Care Unit: A Systematic Review of Stakeholders' Views and Influential Factors

“…After removing 1572 duplicates, 7841 unique records were obtained and screened. We reviewed 167 full-text studies, of which 33 studies were finally included [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59].…”

“…However, there is often a lack of agreement among physicians, patients, and families over their respective roles in EOL decision-making [4]. The involvement of nurses has also been a point of interest in various studies [5][6][7][8][9][10][11][12][13][14][15][16][17], while the views of the general public have not been comprehensively examined [18].…”

Intensive Care Unit Nurses' Attitudes Toward Truth-Telling, Life-Sustaining Treatment, and Decision-Making Intention for End-of-Life Patients

“…However, the results showed that the consent rate of ICU nurses in assisting physicians in signing the decision letter was low. Multiple studies have shown that nurse involvement in the end-of-life decision-making process is widely recognized, but in practice, nurses are not included 29,30 . In the traditional Chinese medical hierarchy, physicians lead communication with patients and families about decisions, and they are major leaders of decision making, whereas nurses have a low participation rate 31 .…”

“…Multiple studies have shown that nurse involvement in the end-of-life decision-making process is widely recognized, but in practice, nurses are not included. 29,30 In the traditional Chinese medical hierarchy, physicians lead communication with patients and families about decisions, and they are major leaders of decision making, whereas nurses have a low participation rate. 31 In fact, nurses, doctors, and patients are equal and share information in shared decision making.…”

End-of-life patients and palliative care in intensive care units in Croatia: the current situation

“…Before the publication of the guidelines, Croatian scientists conducted an extensive research project investigating the values and decisions in end-of-life situations. A part of the project was a study exploring the attitudes and experiences of physicians and nurses treating end-of-life patients in ICUs ( 4 ). According to the study, decisions on LST limitation were not frequently made.…”