End-of-Life Decision Making in ICUs: Roles and Relationships of Key Players

DESCRIPTION (provided by applicant): This is a proposal for a secondary analysis of data collected in a parent study, a study of end-of-life decision making (EOLDM) in intensive care units (ICUs). The parent R01 funded ethnographic studies of EOLDM in four adult ICUs in a single hospital. The focus of that study was cultural differences among the four ICUs and the effect of those cultures on cases with problematic decisions. That work has been published (Baggs et al., 2007). The current proposal has new research aims. It is designed to focus in depth on the roles of the key persons in EOLDM in ICUs (patients, family members, physicians, nurses) and the inter-relationships of those persons. A new descriptive and interpretive qualitative analysis will be conducting using the information rich data gathered in the previous study (including 254 fieldnotes from observations, artifacts, 157 interviews of 130 people, and 22 recordings or extensive notes from family meetings involving EOLDM). The data have all been transcribed and entered into a software data management program useful in qualitative analysis (ATLAS.ti). The long term goals of this program of research are to improve the process of EOLDM and the EOL decision made in ICUs, the site of many of these decisions. There is continued evidence that decision made are not optimal, and that the process of decision making is distressing for patients, families, and health care providers. The proposed study will help support interventions respectful of the perspectives of all participants in EOLDM. PUBLIC HEALTH RELEVANCE: This proposal for a secondary analysis of data collected in a parent ethnographic study of end-of-life decision making (EOLDM) in intensive care units (ICUs). The current proposal uses qualitative description to focus on the roles of the key persons in EOLDM in ICUs (patients, family members, physicians, nurses) and the inter-relationships of those persons. The study will help support interventions respectful of the perspectives of all participants in EOLDM.