ArticleIntensive care medicine2013
Factors that contribute to physician variability in decisions to limit life support in the ICU: a qualitative study.
Article in Intensive care medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 2 of them syntheses that pooled it.
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Who cites it
21 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Psychological Determinants of Physician Variation in End-of-Life Treatment Intensity: A Systematic Review and Meta-Synthesis.Journal of general internal medicine · 2023Pooled it
- Do-not-intubate orders in patients with acute respiratory failure: a systematic review and meta-analysis.Intensive care medicine · 2020Pooled it
- Physicians' decision-making when managing pediatric patients with prolonged disorders of consciousness: A qualitative study.European journal of neurology · 2022Article
- Variability of Prognostic Communication in Critically Ill Neurologic Patients: A Pilot Multicenter Mixed-Methods Study.Critical care explorations · 2022Article
- Predictors and Direct Cost Estimation of Long Stays in Pediatric Intensive Care Units in Saudi Arabia: A Mixed Methods Study.Risk management and healthcare policy · 2021Article
- Burying our mistakes: Dealing with prognostic uncertainty after severe brain injury.Bioethics · 2020Article
- Framework to Support the Process of Decision-Making on Life-Sustaining Treatments in the ICU: Results of a Delphi Study.Critical care medicine · 2020Article
- Neurocritical care physicians' doubt about whether to withdraw life-sustaining treatment the first days after devastating brain injury: an interview study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2019Article
- Clinical Requirements of Future Patient Monitoring in the Intensive Care Unit: Qualitative Study.JMIR medical informatics · 2019Article
- Limitation of therapeutic effort experienced by intensive care nurses.Nursing ethics · 2018Article
- Differences in Code Status and End-of-Life Decision Making in Patients With Limited English Proficiency in the Intensive Care Unit.Mayo Clinic proceedings · 2018Article
- A qualitative exploration of the discharge process and factors predisposing to readmissions to the intensive care unit.BMC health services research · 2018Article
- Article
- Early Withdrawal Decision-Making in Patients with Coma After Cardiac Arrest: A Qualitative Study of Intensive Care Clinicians.Neurocritical care · 2016Article
- Qualitative research in critical care: Has its time finally come?Journal of the Intensive Care Society · 2016Article
- Withholding or withdrawal of treatment under French rules: a study performed in 43 intensive care units.Annals of intensive care · 2015Article
- The Ethics of Chronic Dialysis for the Older Patient: Time to Reevaluate the Norms.Clinical journal of the American Society of Nephrology : CJASN · 2015Article
- Decision Aids and Shared Decision-Making in Neurocritical Care: An Unmet Need in Our NeuroICUs.Neurocritical care · 2015Article
- Eligibility for organ donation following end-of-life decisions: a study performed in 43 French intensive care units.Intensive care medicine · 2014Observational
- Year in review in Intensive Care Medicine 2013: II. Sedation, invasive and noninvasive ventilation, airways, ARDS, ECMO, family satisfaction, end-of-life care, organ donation, informed consent, safety, hematological issues in critically ill patients.Intensive care medicine · 2014Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeOur aim was to explore reasons for physician variability in decisions to limit life support in the intensive care unit (ICU) utilizing qualitative methodology.
methodsSingle center study consisting of semi-structured interviews with experienced physicians and nurses. Seventeen intensivists from medical (n = 7), surgical (n = 5), and anesthesia (n = 5) critical care backgrounds, and ten nurses from medical (n = 5) and surgical (n = 5) ICU backgrounds were interviewed. Principles of grounded theory were used to analyze the interview transcripts.
resultsEleven factors within four categories were identified that influenced physician variability in decisions to limit life support: (1) physician work environment-workload and competing priorities, shift changes and handoffs, and incorporation of nursing input; (2) physician experiences-of unexpected patient survival, and of limiting life support in physician's family; (3) physician attitudes-investment in a good surgical outcome, specialty perspective, values and beliefs; and (4) physician relationship with patient and family-hearing the patient's wishes firsthand, engagement in family communication, and family negotiation.
conclusionsWe identified several factors which physicians and nurses perceived were important sources of physician variability in decisions to limit life support. Ways to raise awareness and ameliorate the potentially adverse effects of factors such as workload, competing priorities, shift changes, and handoffs should be explored. Exposing intensivists to long term patient outcomes, formalizing nursing input, providing additional training, and emphasizing firsthand knowledge of patient wishes may improve decision making.
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