Swedish intensivists’ experiences and attitudes regarding end‐of‐life decisions

Syrous, Alma Nordenskjöld; Ågård, Anders; Redfors, Maria Kock; Naredi, Silvana; Block, Linda

doi:10.1111/aas.13549

Cited by 8 publications

(7 citation statements)

References 30 publications

(69 reference statements)

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“…End‐of‐life (EOL) issues within intensive care continues to be in focus and have been discussed several times in this journal since one of the first papers appeared more than 25 years ago 1 . More recently it was found that intensivists from Sweden wish to make EOL decisions based on sufficient information like prognosis and broad consent including family 2 …”

mentioning

confidence: 99%

“…Limitation of life-sustaining treatment in the ICU: We need more knowledge End-of-life (EOL) issues within intensive care continues to be in focus and have been discussed several times in this journal since one of the first papers appeared more than 25 years ago. 1 More recently it was found that intensivists from Sweden wish to make EOL decisions based on sufficient information like prognosis and broad consent including family 2 A study presented in this issue of AAS analyses predictors of limitations of life-sustaining treatment (LST) in Finnish ICUs during 2016. 3 Three types of LST were studied: withholding treatment (WH) at admission or during the ICU stay or withdrawal (WD) during the ICU stay.…”

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confidence: 99%

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To live or let die? Limitation of life‐sustaining treatment in the ICU: We need more knowledge

Guidet

2022

Acta Anaesthesiol Scand

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confidence: 99%

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confidence: 99%

To live or let die? Limitation of life‐sustaining treatment in the ICU: We need more knowledge

Guidet

2022

Acta Anaesthesiol Scand

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“…This qualitative study adheres to the Consolidated Criteria for Reporting Qualitative Research guidelines 15 . This study is a substudy of a previously conducted interview study from our group 14 …”

Section: Methodsmentioning

confidence: 99%

“…Physician‐related variability was mostly unquestioned by the respondents. The leading causes of physician‐related variability were identified as the intensivists' personality as well as their personal and professional experiences 14 …”

Section: Introductionmentioning

confidence: 99%

Reasons for physician‐related variability in end‐of‐life decision‐making in intensive care

Syrous

Malmgren

Hergès

et al. 2021

Acta Anaesthesiol Scand

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Background There is increasing evidence that the individual physician is the main factor influencing variability in end‐of‐life decision‐making in intensive care units. End‐of‐life decisions are complex and should be adapted to each patient. Physician‐related variability is problematic as it may result in unequal assessments that affect patient outcomes. The primary aim of this study was to investigate factors contributing to physician‐related variability in end‐of‐life decision‐making. Method This is a qualitative substudy of a previously conducted study. In‐depth thematic analysis of semistructured interviews with 19 critical care specialists from five different Swedish intensive care units was performed. Interviews took place between 1 February 2017 and 31 May 2017. Results Factors influencing physician‐related variability consisted of different assessment of patient preferences, as well as intensivists' personality and values. Personality was expressed mainly through pace and determination in the decision‐making process. Personal prejudices appeared in decisions, but few respondents had personally witnessed this. Avoidance of criticism and conflicts as well as individual strategies for emotional coping were other factors that influenced physician‐related variability. Many respondents feared criticism for making their assessments, and the challenging nature of end‐of‐life decision‐making lead to avoidance as well as emotional stress. Conclusion Variability in end‐of‐life decision‐making is an important topic that needs further investigation. It is imperative that such variability be acknowledged and addressed in a more formal and transparent manner. The ethical issues faced by intensivists have recently been compounded by the devastating impact of the COVID‐19 pandemic, demonstrating in profound terms the importance of the topic.

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“…14 Consensus among the entire clinical team is one of the first and most important steps in withholding/withdrawal of non-beneficial treatments for ICU clinicians, who are at higher risk of moral distress and burnout. 41,[46][47][48] Patients admitted to ICU are usually not able to express their preferences about end of life care directly. 16 Therefore, intensivists have to acknowledge any advance directive and interact with patient's surrogate decision maker and family.…”

Section: End Of Life Decision Makingmentioning

confidence: 99%

Palliative Care Principles and Anesthesiology Clinical Practice: Current Perspectives

Catalisano

Ippolito

Mariño

et al. 2021

JMDH

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Background Palliative care is a person-centered approach aiming to relieve patient’s health-related suffering and it is often needed when caring for critically ill patients to manage symptoms and identify goals of care. Aim To describe the integration of palliative care principles in anesthesiology clinical practice, within and outside the ICU and to analyze the additional challenges that COVID-19 pandemic is posing in this context. Methods For the purpose of this review, PubMed database was searched for studies concerning palliative care and end of life care, in contexts involving anesthesiologists and intensivists, published in the last 5 years. Results Anesthesiologists and intensivists integrate palliative care within their daily practice providing symptoms management as well as family counseling. High-quality communicational skills are fundamental for anesthesiologists and intensivists especially when interfacing with surrogate decision makers in the ICU or with patients in the preoperative setting while discussing goals of care. Coronavirus disease 2019 (COVID-19) pandemic has challenged many aspects of palliative care delivery: reduced family presence within the ICU, communication with families through phone calls or video calls, patient–physician relationship mediated by bulky personal protective equipment and healthcare workers physical and psychological distress due to the increased workload and limitations in resources are some of the most evident. Conclusion Anesthesiologists and intensivists are increasingly facing challenging clinical situations where principles and practice of palliative care have to be applied. In this sense, increasing knowledge on palliative care and providing specific training would allow to deliver high-quality symptom management, family counseling and end of life guidance in critical care settings. COVID-19 pandemic sets additional difficulties to palliative care delivery.

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Swedish intensivists’ experiences and attitudes regarding end‐of‐life decisions

Cited by 8 publications

References 30 publications

To live or let die? Limitation of life‐sustaining treatment in the ICU: We need more knowledge

To live or let die? Limitation of life‐sustaining treatment in the ICU: We need more knowledge

Reasons for physician‐related variability in end‐of‐life decision‐making in intensive care

Palliative Care Principles and Anesthesiology Clinical Practice: Current Perspectives

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