Empathy and Life Support Decisions in Intensive Care Units

Selph, R. Brac; Shiang, Julia; Engelberg, Ruth A.; Curtis, J. Randall; White, Douglas B.

doi:10.1007/s11606-008-0643-8

Cited by 135 publications

(79 citation statements)

References 38 publications

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“…higher family satisfaction with clinician communication 28 as have empathic responses to family concerns expressed during these conferences; this may represent another avenue for enhancing families' perception of support for decision-making. 29 Finally, one cause for dissatisfaction with decision-making may be meet the needs of each patient and family, assessing with the family members what their preferences are for hearing prognostic information and receiving recommendations. [25][26][27] Further, explicit clinician statements of support for decisions made during family conferences have been shown to be associated with related to the appropriateness of the patient's ICU admission; that is, was the patient likely to benefi t from the care provided?…”

Section: Components Of Family Satisfaction That Predict Family-assessmentioning

confidence: 99%

Identifying Elements of ICU Care That Families Report as Important But Unsatisfactory

Osborn

Curtis

Nielsen

et al. 2012

Chest

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Section: Components Of Family Satisfaction That Predict Family-assessmentioning

confidence: 99%

Identifying Elements of ICU Care That Families Report as Important But Unsatisfactory

Osborn

Curtis

Nielsen

et al. 2012

Chest

Self Cite

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“…We know little about these conversations-only that physicians and patients feel uncomfortable with them [2][3][4] , and that they are highly variable in terms of timing 5 , content [6][7][8][9] , and style 10,11 . As a result (and understandably), many physicians do not know their patients' preferences for resuscitation 1 , and many patients have a very poor understanding of their own resuscitation order 2,12 .…”

Section: Introductionmentioning

confidence: 99%

Why Do Patients Agree to a “Do Not Resuscitate” or “Full Code” Order? Perspectives of Medical Inpatients

et al. 2011

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BACKGROUND:The majority of patients who die in hospital have a "Do Not Resuscitate" (DNR) order in place at the time of their death, yet we know very little about why some patients request or agree to a DNR order, why others don't, and how they view discussions of resuscitation status. METHODS:We conducted semi-structured interviews of English-speaking medical inpatients who had clearly requested a DNR or full code (FC) order after a discussion with their admitting team, and analyzed the transcripts using a modified grounded-theory approach. RESULTS:We achieved conceptual saturation after conducting 44 interviews (27 DNR, 17 FC) over a 4-month period. Patients in the DNR group were much older than those in the FC group, but they had broadly similar admission diagnoses and comorbidities. DNR patients reported much greater familiarity with the subject and described a more positive experience than FC patients with their resuscitation discussions. Participants typically requested FC or DNR orders based on personal, relational or philosophical considerations, but these considerations manifested differently depending on the participant's preference for resuscitation. Most FC patients stated that would not want a prolonged period of life support, and they would not want resuscitation in the event of a poor quality of life. FC and DNR patients understood resuscitation and DNR orders differently. DNR patients described resuscitation in graphic, concrete terms that emphasized suffering and futility, and DNR orders in terms of comfort or natural processes. FC patients understood resuscitation in an abstract sense as something that restores life, while DNR orders were associated with substandard care or even euthanasia.CONCLUSION: Our study identified important differences and commonalities between the perspectives of DNR and FC patients. We hope that this information can be used to help physicians better understand the needs of their patients when discussing resuscitation.

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“…For example, because many people suffer pangs of separation at a death, health professionals should address those feelings expressly. 22 Doing so may promote closure for the grieving. 20,[23][24][25] Health professionals should also attend to beliefs such as those about the signs and duration of the time of death.…”

Section: Discussionmentioning

confidence: 99%

Patients' diverse beliefs about what happens at the time of death

Perkins

Cortez²,

Hazuda

2011

Journal of Hospital Medicine

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BACKGROUND:Beliefs about what happens at the time of death surely affect a patient's whole dying experience and could help guide end‐of‐life care. Yet virtually no research describes those beliefs. This exploratory study begins the descriptive process.METHODS:Assuming culture is key, we interviewed 26 Mexican‐American (MA), 18 Euro‐American (EA), and 14 African‐American (AA) inpatients about their beliefs concerning what happens at the time of death.RESULTS:One belief, that death separates the dead from the living, was widespread. Majorities of all 3 ethnic group samples and of 5 of the 6 gender subsamples expressed this belief, saying the dead “go” or “leave” from this life. Other beliefs differed by ethnic group or gender. For example, more EAs (50%) than others said death is a momentary event, and more MAs (35%) than others said death involves “being taken” by an external force (always God or Jesus). Furthermore, considerably more EA women (45%) than others said some senses persist after death. In contrast, the physiologic signs that participants cited as defining the exact time of death varied from individual to individual with no ethnic or gender pattern, and no one sign predominated.CONCLUSIONS:A few beliefs about what happens at the time of death may characterize Americans in general; many other beliefs may characterize only certain ethnic groups, genders, or individuals. To identify such beliefs and to use them to guide end‐of‐life care, hospitalists and other health professionals may have to elicit them directly from patients or survivors. Journal of Hospital Medicine 2012. © 2011 Society of Hospital Medicine

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Empathy and Life Support Decisions in Intensive Care Units

Cited by 135 publications

References 38 publications

Identifying Elements of ICU Care That Families Report as Important But Unsatisfactory

Identifying Elements of ICU Care That Families Report as Important But Unsatisfactory

Why Do Patients Agree to a “Do Not Resuscitate” or “Full Code” Order? Perspectives of Medical Inpatients

Patients' diverse beliefs about what happens at the time of death

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