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Am J Crit Care. 2017 Jul;26(4):336-341. doi: 10.4037/ajcc2017774.

Communication and Decision-Making About End-of-Life Care in the Intensive Care Unit.

Author information

1
Laura Anne Brooks is a lecturer in the School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia. Elizabeth Manias is a research professor, Faculty of Health, School of Nursing and Midwifery, Deakin University; adjunct professor of medicine, The Royal Melbourne Hospital, and honorary professor, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia. Patricia Nicholson is an associate professor in the School of Nursing and Midwifery, Deakin University; and honorary senior lecturer, Nursing Department, School of Health Sciences, The University of Melbourne. laura.brooks@deakin.edu.au.
2
Laura Anne Brooks is a lecturer in the School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia. Elizabeth Manias is a research professor, Faculty of Health, School of Nursing and Midwifery, Deakin University; adjunct professor of medicine, The Royal Melbourne Hospital, and honorary professor, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia. Patricia Nicholson is an associate professor in the School of Nursing and Midwifery, Deakin University; and honorary senior lecturer, Nursing Department, School of Health Sciences, The University of Melbourne.

Abstract

BACKGROUND:

Clinicians in the intensive care unit commonly face decisions involving withholding or withdrawing life-sustaining therapy, which present many clinical and ethical challenges. Communication and shared decision-making are key aspects relating to the transition from active treatment to end-of-life care.

OBJECTIVES:

To explore the experiences and perspectives of nurses and physicians when initiating end-of-life care in the intensive care unit.

METHODS:

The study was conducted in a 24-bed intensive care unit in Melbourne, Australia. An interpretative, qualitative inquiry was used, with focus groups as the data collection method. Intensive care nurses and physicians were recruited to participate in a discipline-specific focus group. Focus group discussions were audio-recorded, transcribed, and subjected to thematic data analysis.

RESULTS:

Five focus groups were conducted; 17 nurses and 11 physicians participated. The key aspects discussed included communication and shared decision-making. Themes related to communication included the timing of end-of-life care discussions and conducting difficult conversations. Implementation and multidisciplinary acceptance of end-of-life care plans and collaborative decisions involving patients and families were themes related to shared decision-making.

CONCLUSIONS:

Effective communication and decision-making practices regarding initiating end-of-life care in the intensive care unit are important. Multidisciplinary implementation and acceptance of end-of-life care plans in the intensive care unit need improvement. Clear organizational processes that support the introduction of nurse and physician end-of-life care leaders are essential to optimize outcomes for patients, family members, and clinicians.

PMID:
28668920
DOI:
10.4037/ajcc2017774
[Indexed for MEDLINE]
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