The decision-making process in families of terminal ICU patients

Abstract

The objective of this research is to investigate family members’ perceptions as to the end-of-life decision-making process in an ICU. The authors conducted a qualitative descriptive study in which they interviewed six family members of critically ill patients admitted to the ICU of a private hospital. Five categories of analysis emerged from the examination of the material. This study will discuss two of those categories: the decision-making process and the relationship with the medical staff. The results indicate that family members were satisfied with communication with the medical staff, an important aspect for the decision-making process. Within this context, the shared model, prioritization of palliative care and identification of futile treatments prevailed, aimed at ensuring the patient’s comfort and dignity at the end of life. The results also reveal the need for integration of palliative care in ICUs, particularly in end-of-life situations.

A systematic review defining non-beneficial and inappropriate end-of-life treatment in patients with non-cancer diagnoses: theoretical development for multi-stakeholder intervention design in acute care settings

“…The problem of not clearly communicating treatment and prognosis to lay people/patients was notable. For instance, a qualitative study among family members of terminal ICU patients in Brazil, highlighted that unsatisfactory communication stemmed from the lack of clarity, objectivity, and emotional preparedness of clinicians when communicating with family members [ 83 ]. Ineffective communication can lead to medical paternalism; meaning there is a lack of sufficient communication from clinicians such that agreement in goals of care and appropriate treatment, from the patient and family/guardian perspectives, can be seen to be impeded.…”

Família, tomada de decisão e apoio dos profissionais nas unidades de terapia intensiva: revisão integrativa

“…Para melhorar as práticas com famílias, faz-se necessário conhecer as melhores estratégias, as quais podem ser utilizadas para promover a aproximação dos profissionais com os familiares de pacientes internados na UTI e serem benéficas no processo de tomada de decisão desses. 3 Assim como as oportunidades oferecidas às famílias para expor suas preferências, competências e forças, que contribuirão para que estas se sintam integradas ao ambiente e à equipe, a fim de melhorar a avaliação da qualidade da atenção oferecida. 4 Dessa forma, esse estudo objetivou analisar a produção científica sobre as condutas de apoio dos profissionais às famílias e a participação destas no processo de tomada de decisão diante da internação de um dos seus integrantes.…”

Factors Influencing Potentially Futile Treatments at the End of Life in a Multiethnic Asian Cardiology Setting: A Qualitative Study

“…Cardiovascular diseases such as chronic heart failure are some of the leading causes of mortality. [1][2][3] Although there have been improvements in the management of these diseases, 4,5 healthcare professionals in cardiology are increasingly facing patients with more advanced diseases nearing end-of-life. 4 Intensive curative treatment may not be considered to be beneficial to a patient nearing end-of-life in terms of improving quality of life and prolonging life of acceptable quality, and is often defined as "futile" or "non-beneficial" treatments.…”