ArticleScandinavian journal of trauma, resuscitation and emergency medicine2019
Neurocritical care physicians' doubt about whether to withdraw life-sustaining treatment the first days after devastating brain injury: an interview study.
Article in Scandinavian journal of trauma, resuscitation and emergency medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 39 citations in OpenAlex.
- Psychological Determinants of Physician Variation in End-of-Life Treatment Intensity: A Systematic Review and Meta-Synthesis.Journal of general internal medicine · 2023Pooled it
- Article
- Clinical and Ethical Approaches to Medical Futility in End-of-Life Care: A Scoping Review.Cureus · 2026Review
- Treatment-Limiting Decisions in Neurointensive Care: Withholding or Withdrawal of Life-Sustaining Measures.Acta anaesthesiologica Scandinavica · 2026Observational
- Patterns in withdrawal of life-sustaining treatment in trauma patients with and without moderate to severe traumatic brain injury: an ACS-TQIP retrospective cohort study.Trauma surgery & acute care open · 2026Article
- Delayed Withdrawal of Life-Sustaining Treatment in Disorders of Consciousness: Practical and Theoretical Considerations.Neurocritical care · 2025Review
- Article
- Intensive care admission aiming at organ donation. Pro.Intensive care medicine · 2024Article
- Citizen attitudes to non-treatment decision making: a Norwegian survey.BMC medical ethics · 2023Article
- Early prediction model of brain death in out-of-hospital cardiac arrest patients: a single-center retrospective and internal validation analysis.BMC emergency medicine · 2022Article
- Extending the Ring Theory of Personhood to the Care of Dying Patients in Intensive Care Units.Asian bioethics review · 2022Article
- Inter-physician variability in strategies linked to treatment limitations after severe traumatic brain injury; proactivity or wait-and-see.BMC medical ethics · 2021Article
- The impact of caring for dying patients in intensive care units on a physician's personhood: a systematic scoping review.Philosophy, ethics, and humanities in medicine : PEHM · 2020Article
- Traumatic brain injury-the effects of patient age on treatment intensity and mortality.BMC neurology · 2020Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMultilevel uncertainty exists in the treatment of devastating brain injury and variation in end-of-life decision-making is a concern. Cognitive and emotional doubt linked to making challenging decisions have not received much attention. The aim of this study was to explore physicians´ doubt related to decisions to withhold or withdraw life-sustaining treatment within the first 72 h after devastating brain injury and to identify the strategies used to address doubt.
methodSemi-structured interviews were conducted with 18 neurocritical care physicians in a Norwegian trauma centre (neurosurgeons, intensivists and rehabilitation specialists) followed by a qualitative thematic analysis.
resultAll physicians described feelings of doubt. The degree of doubt and how they dealt with it varied. Institutional culture, ethics climate and individual physicians´ values, experiences and emotions seemed to impact judgements and decisions. Common strategies applied by physicians across specialities when dealing with uncertainty and doubt were: 1. Provision of treatment trials 2. Using time as a coping strategy 3. Collegial counselling and interdisciplinary consensus seeking 4. Framing decisions as purely medical.
conclusionDecisions regarding life-sustaining treatment after devastating brain injury are crafted in a stepwise manner. Feelings of doubt are frequent and seem to be linked to the recognition of fallibility. Doubt can be seen as positive and can foster open-mindedness towards the view of others, which is one of the prerequisites for a good ethical climate. Doubt in this context tends to be mitigated by open interdisciplinary discussions acknowledging doubt as rational and a normal feature of complex decision-making.
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