Family Reliance on Physicians' Decisions in Life-Sustaining Treatments in Acute-on-Chronic Respiratory Diseases in a Respiratory ICU: A Single-Center Study

Abstract

BACKGROUND: In ICUs, many patients are unable to participate in decision-making regarding life-sustaining treatments. This study evaluated the opinions of family members about family and physician participation in life-sustaining treatment decisions and examined factors that influence those decisions. METHODS: This was a prospective exploratory observational study that used convenience sampling. Inquiry interviews were conducted over a 3-year period, with 126 family members (out of 303 potential participants) of patients with acute-on-chronic respiratory failure, who had been admitted to the respiratory ICU and were dependent on invasive or noninvasive mechanical ventilation. Patients of < 18 years old, with a stay of < 3 days, and oncologic patients were excluded. RESULTS: Ninety-eight percent (123/126) of the participant family members had an opinion about their involvement in decision-making about life-sustaining treatments. Physician choice was preferred by 54/123 (44%), 55/123 (45%) wished to share the decision with the physician, and 14/123 (11%) wished the family to decide. All the patients were incompetent at the time of inquiry. Autonomy prior to admission to the respiratory ICU influenced the decision. CONCLU-SIONS: A majority of the families relied on physicians to help in the decision-making process about life-sustaining treatments in patients with acute-on-chronic respiratory diseases. From the family's point of view, the principle of autonomy can be exercised by delegating the decision-making process to the physician. To assume a uniform ethical conduct is to antagonize the definition of ethics.

State anxiety, uncertainty in illness, and needs of family members of critically ill patients and their experiences with family-centered multidisciplinary rounds: A mixed model study

“…Most interviewees expressed expectations and hopes for favorable outcomes, as they perceived the ICU as a place where patients could benefit from "machines" and "where the patient can receive dedicated intensive care" (i.e., a place in which medical knowledge and technology, as well as human resources, were concentrated) (No. 1,No. 3,No.…”

“…Although a growing number of patients seek active involvement in making decisions about their own healthcare [2], critically ill patients in ICUs are likely to be incapable of proactively participating in discussions regarding treatment plan and decision-making due to various medical conditions. Consequently, family members of patients in ICUs play a crucial part in substitute decision-making, psychological support, and follow-up care [3,4]. Despite their significant role, families of critically ill patients also experience structural, emotional, and financial crises when their relatives are admitted to the ICU [5].…”

Effect of the Integrated Prospective Payment Program on Family Members' Knowledge and Acceptance of Hospice Care of Patients on Prolonged Mechanical Ventilation

“…A variety of factors influence the hospice care decisionmaking process, such as health care expenditure, legal risks, religion, and the experience and life attitudes of physicians, families, or surrogates. 28,41,[45][46][47][48] Our study results indicate that patients staying in respiratory care centers, male patients' families, female respondents, and children and grandchildren of patients had a greater willingness to declare their desire to have hospice care or to withhold/ withdraw life-sustaining treatment. In addition, only 28% of terminal cancer patients in central Taiwan had signed a do-not-resuscitate order themselves; most of these decisions were made by family members.…”

Korean nurses’ attitude towards withdrawing life sustaining treatment: A review of literature

“…Nurses give care for 24hrs nearby patients and spend most of time with patients at the end of life [8], so they can understand patients intention and wishes. Patients and their family make withdrawing life sustaining decision based on medical staff 's attitude and opinion [9,10]. Attitudes toward withdrawing life sustaining treatment are subjective and vary depending on personal characteristics and values [9,11].…”