The role of advance directives in end-of-life decisions in Austria: survey of intensive care physicians

Schaden, Eva; Herczeg, Petra; Hacker, Stefan; Schopper, Andrea; Krenn, Claus G.

doi:10.1186/1472-6939-11-19

Cited by 30 publications

(32 citation statements)

References 17 publications

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“…These figures are higher than those reported by Schaden et al from intensive care physicians [10] and meet with expectations of the patients [11]. …”

Section: Discussionsupporting

confidence: 82%

Survey on German Palliative Care Specialists’ Experiences with Advance Directives

Zenz

2016

Pain Ther

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IntroductionAdvance directives (AD) play a central role in end-of-life treatments, intensive care, and palliative care. However, little is known about the experiences of healthcare professionals with ADs. This study reports on palliative care professionals’ views on advance directives (AD).MethodsA questionnaire was handed out to attendants of a palliative care symposium.ResultsComplete answers were obtained from 126 physicians and 276 nurses. Almost all physicians and nurses had treated patients with an AD, and the majority more than 10 patients. The most frequent refusal by the patients was resuscitation (87.8%) followed by intensive care (79.1%), artificial ventilation, and nutrition. The most frequent wish was pain therapy (92.3%) followed by allowing the natural course of the illness (64.4%). The wish for hospice treatment (44.8%) or spiritual care (39.3%) was less frequent.DiscussionThe results hint at fears and deficits in the care of patients at the end of life. Often the quality of life and not the quantity of days remaining is in the center of a patient’s will and points to the growing importance of palliative care.ConclusionADs are well established among palliative care professionals and regarded as helpful for patients at the end of life.

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“…These figures are higher than those reported by Schaden et al from intensive care physicians [10] and meet with expectations of the patients [11]. …”

Section: Discussionsupporting

confidence: 82%

Survey on German Palliative Care Specialists’ Experiences with Advance Directives

Zenz

2016

Pain Ther

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“…(2010) [ 37 ] Greece To study the frequency, type and rationale for limiting life support in Greek multidisciplinary ICUs, the clinical and demographic parameters associated with limiting life support, and the participation of relatives in the decision-making process Prospective observational study, with an anonymous questionnaire in 8 multidisciplinary, general hospital-affiliated ICUs 304 patients and their physicians 7 Schaden et al . (2010) [ 38 ] Austria To explore Austrian intensive care physicians’ experiences with, and their acceptance of, the new advance directives legislation 2 years after enactment Survey of all ICUs in Austria 139 participants 6 Westphal and McKee (2009) [ 39 ] USA To examine differences between physicians and nurses regarding knowledge about advance directives and do-not-resuscitate orders, and the personal factors that underlie beliefs and practices related to the use of advance directives and do-not-resuscitate orders Survey 53 physicians 6 Sprung et al . (2008) [ 40 ] European countries (17 countries) To evaluate physician documentation and the reasoning, considerations and difficulties in end-of-life decision-making in ICUs Prospective study of end-of-life practices and decisions in consecutive patients who died or were subject to any limitation of life-saving interventions in 37 ICUs in 17 European countries ICU physicians 6 Collins et al .…”

Section: Resultsmentioning

confidence: 99%

“…Physicians are uncertain about the legal standing of, and have no experience with, advance directives (weak evidence) [ 38 ]. Establish and document clear, realistic, and appropriate goals of care in consultation with the patient and family (QI 21) …”

Section: Resultsmentioning

confidence: 99%

Physician-related barriers to communication and patient- and family-centred decision-making towards the end of life in intensive care: a systematic review

2014

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IntroductionAlthough many terminally ill people are admitted to an intensive care unit (ICU) at the end of life, their care is often inadequate because of poor communication by physicians and lack of patient- and family-centred care. The aim of this systematic literature review was to describe physician-related barriers to adequate communication within the team and with patients and families, as well as barriers to patient- and family-centred decision-making, towards the end of life in the ICU. We base our discussion and evaluation on the quality indicators for end-of-life care in the ICU developed by the Robert Wood Johnson Foundation Critical Care End-of-Life Peer Workgroup.MethodFour electronic databases (MEDLINE, Embase, CINAHL and PsycINFO) were searched, using controlled vocabulary and free text words, for potentially relevant records published between 2003 and 2013 in English or Dutch. Studies were included if the authors reported on physician-related and physician-reported barriers to adequate communication and decision-making. Barriers were categorized as being related to physicians’ knowledge, physicians’ attitudes or physicians’ practice. Study quality was assessed using design-specific tools. Evidence for barriers was graded according to the quantity and quality of studies in which the barriers were reported.ResultsOf 2,191 potentially relevant records, 36 studies were withheld for data synthesis. We determined 90 barriers, of which 46 were related to physicians’ attitudes, 24 to physicians’ knowledge and 20 to physicians’ practice. Stronger evidence was found for physicians’ lack of communication training and skills, their attitudes towards death in the ICU, their focus on clinical parameters and their lack of confidence in their own judgment of their patient’s true condition.ConclusionsWe conclude that many physician-related barriers hinder adequate communication and shared decision-making in ICUs. Better physician education and palliative care guidelines are needed to enhance knowledge, attitudes and practice regarding end-of-life care. Patient-, family- and health care system–related barriers need to be examined.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0604-z) contains supplementary material, which is available to authorized users.

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“…Research suggests that such conflicts are on the rise in the nursing field, due both to the increasing complexity of care and the scientific and technological advances which have been made in recent decades. In this regard, critical care units are a setting that is especially prone to conflict [1-14]. Various authors have suggested that the ethical conflicts experienced by critical care nurses stem from three main sources: the relationships with patients and their families, the provision of certain treatments and/or the characteristics of the setting in which the clinical team works.…”

Section: Introductionmentioning

confidence: 99%

Development process and initial validation of the Ethical Conflict in Nursing Questionnaire-Critical Care Version

2013

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BackgroundEthical conflicts are arising as a result of the growing complexity of clinical care, coupled with technological advances. Most studies that have developed instruments for measuring ethical conflict base their measures on the variables ‘frequency’ and ‘degree of conflict’. In our view, however, these variables are insufficient for explaining the root of ethical conflicts. Consequently, the present study formulates a conceptual model that also includes the variable ‘exposure to conflict’, as well as considering six ‘types of ethical conflict’. An instrument was then designed to measure the ethical conflicts experienced by nurses who work with critical care patients. The paper describes the development process and validation of this instrument, the Ethical Conflict in Nursing Questionnaire Critical Care Version (ECNQ-CCV).MethodsThe sample comprised 205 nursing professionals from the critical care units of two hospitals in Barcelona (Spain). The ECNQ-CCV presents 19 nursing scenarios with the potential to produce ethical conflict in the critical care setting. Exposure to ethical conflict was assessed by means of the Index of Exposure to Ethical Conflict (IEEC), a specific index developed to provide a reference value for each respondent by combining the intensity and frequency of occurrence of each scenario featured in the ECNQ-CCV. Following content validity, construct validity was assessed by means of Exploratory Factor Analysis (EFA), while Cronbach’s alpha was used to evaluate the instrument’s reliability. All analyses were performed using the statistical software PASW v19.ResultsCronbach’s alpha for the ECNQ-CCV as a whole was 0.882, which is higher than the values reported for certain other related instruments. The EFA suggested a unidimensional structure, with one component accounting for 33.41% of the explained variance.ConclusionsThe ECNQ-CCV is shown to a valid and reliable instrument for use in critical care units. Its structure is such that the four variables on which our model of ethical conflict is based may be studied separately or in combination. The critical care nurses in this sample present moderate levels of exposure to ethical conflict. This study represents the first evaluation of the ECNQ-CCV.

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The role of advance directives in end-of-life decisions in Austria: survey of intensive care physicians

Cited by 30 publications

References 17 publications

Survey on German Palliative Care Specialists’ Experiences with Advance Directives

Survey on German Palliative Care Specialists’ Experiences with Advance Directives

Physician-related barriers to communication and patient- and family-centred decision-making towards the end of life in intensive care: a systematic review

Development process and initial validation of the Ethical Conflict in Nursing Questionnaire-Critical Care Version

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