Decisions About Life-Sustaining Treatment

Impact of Physicians’ Behaviors on the Family

Virginia Tilden, Susan Tolle, Michael J. Garland, Christine A. Nelson

Research output: Contribution to journalArticle

149 Citations (Scopus)

Abstract

Background: Despite the growing availability of advance directives, most patients in the intensive care unit lack written directives, and, therefore, consultation with families about treatment decisions remains the rule. In the context of decision making about withdrawing life-sustaining treatments, we investigated which physician and nurse behaviors families find supportive and which behaviors increase the family's burden. Methods: We conducted intensive 1- to 2-hour-long individual interviews using a semistructured interview protocol with 32 family members of patients without advance directives whose deaths followed a stay in the intensive care unit and withdrawal of treatment. We analyzed more than 700 pages of verbatim interview data using content analysis techniques and achieved more than 90% interrater agreement on data codes. Results: Themes emerged as families identified selected physician and nursing behaviors as helpful: encouraging advanced planning, timely communication, clarification of families’ roles, facilitating family consensus, and accommodating family's grief. Behaviors that made families feel excluded or increased their burden included postponing discussions about treatment withdrawal, delaying withdrawal once scheduled, placing the full burden of decision making on one person, withdrawing from the family, and defining death as a failure. Conclusions: Study findings provide an increased understanding of the unmet needs of families and serve to guide physicians and nurses in reducing actions that increase families’ burdens as they participate in treatment withdrawal decisions.

Original languageEnglish (US)
Pages (from-to)633-638
Number of pages6
JournalArchives of Internal Medicine
Volume155
Issue number6
DOIs
StatePublished - Mar 27 1995

Fingerprint

Physicians
Therapeutics
Advance Directives
Interviews
Intensive Care Units
Decision Making
Nurses
Grief
Consensus
Nursing
Referral and Consultation
Communication

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Decisions About Life-Sustaining Treatment : Impact of Physicians’ Behaviors on the Family. / Tilden, Virginia; Tolle, Susan; Garland, Michael J.; Nelson, Christine A.

In: Archives of Internal Medicine, Vol. 155, No. 6, 27.03.1995, p. 633-638.

Research output: Contribution to journalArticle

@article{8e7fd7cfa411408db637308b5eec6f71,
title = "Decisions About Life-Sustaining Treatment: Impact of Physicians’ Behaviors on the Family",
abstract = "Background: Despite the growing availability of advance directives, most patients in the intensive care unit lack written directives, and, therefore, consultation with families about treatment decisions remains the rule. In the context of decision making about withdrawing life-sustaining treatments, we investigated which physician and nurse behaviors families find supportive and which behaviors increase the family's burden. Methods: We conducted intensive 1- to 2-hour-long individual interviews using a semistructured interview protocol with 32 family members of patients without advance directives whose deaths followed a stay in the intensive care unit and withdrawal of treatment. We analyzed more than 700 pages of verbatim interview data using content analysis techniques and achieved more than 90{\%} interrater agreement on data codes. Results: Themes emerged as families identified selected physician and nursing behaviors as helpful: encouraging advanced planning, timely communication, clarification of families’ roles, facilitating family consensus, and accommodating family's grief. Behaviors that made families feel excluded or increased their burden included postponing discussions about treatment withdrawal, delaying withdrawal once scheduled, placing the full burden of decision making on one person, withdrawing from the family, and defining death as a failure. Conclusions: Study findings provide an increased understanding of the unmet needs of families and serve to guide physicians and nurses in reducing actions that increase families’ burdens as they participate in treatment withdrawal decisions.",
author = "Virginia Tilden and Susan Tolle and Garland, {Michael J.} and Nelson, {Christine A.}",
year = "1995",
month = "3",
day = "27",
doi = "10.1001/archinte.1995.00430060097012",
language = "English (US)",
volume = "155",
pages = "633--638",
journal = "JAMA Internal Medicine",
issn = "2168-6106",
publisher = "American Medical Association",
number = "6",

}

TY - JOUR

T1 - Decisions About Life-Sustaining Treatment

T2 - Impact of Physicians’ Behaviors on the Family

AU - Tilden, Virginia

AU - Tolle, Susan

AU - Garland, Michael J.

AU - Nelson, Christine A.

PY - 1995/3/27

Y1 - 1995/3/27

N2 - Background: Despite the growing availability of advance directives, most patients in the intensive care unit lack written directives, and, therefore, consultation with families about treatment decisions remains the rule. In the context of decision making about withdrawing life-sustaining treatments, we investigated which physician and nurse behaviors families find supportive and which behaviors increase the family's burden. Methods: We conducted intensive 1- to 2-hour-long individual interviews using a semistructured interview protocol with 32 family members of patients without advance directives whose deaths followed a stay in the intensive care unit and withdrawal of treatment. We analyzed more than 700 pages of verbatim interview data using content analysis techniques and achieved more than 90% interrater agreement on data codes. Results: Themes emerged as families identified selected physician and nursing behaviors as helpful: encouraging advanced planning, timely communication, clarification of families’ roles, facilitating family consensus, and accommodating family's grief. Behaviors that made families feel excluded or increased their burden included postponing discussions about treatment withdrawal, delaying withdrawal once scheduled, placing the full burden of decision making on one person, withdrawing from the family, and defining death as a failure. Conclusions: Study findings provide an increased understanding of the unmet needs of families and serve to guide physicians and nurses in reducing actions that increase families’ burdens as they participate in treatment withdrawal decisions.

AB - Background: Despite the growing availability of advance directives, most patients in the intensive care unit lack written directives, and, therefore, consultation with families about treatment decisions remains the rule. In the context of decision making about withdrawing life-sustaining treatments, we investigated which physician and nurse behaviors families find supportive and which behaviors increase the family's burden. Methods: We conducted intensive 1- to 2-hour-long individual interviews using a semistructured interview protocol with 32 family members of patients without advance directives whose deaths followed a stay in the intensive care unit and withdrawal of treatment. We analyzed more than 700 pages of verbatim interview data using content analysis techniques and achieved more than 90% interrater agreement on data codes. Results: Themes emerged as families identified selected physician and nursing behaviors as helpful: encouraging advanced planning, timely communication, clarification of families’ roles, facilitating family consensus, and accommodating family's grief. Behaviors that made families feel excluded or increased their burden included postponing discussions about treatment withdrawal, delaying withdrawal once scheduled, placing the full burden of decision making on one person, withdrawing from the family, and defining death as a failure. Conclusions: Study findings provide an increased understanding of the unmet needs of families and serve to guide physicians and nurses in reducing actions that increase families’ burdens as they participate in treatment withdrawal decisions.

UR - http://www.scopus.com/inward/record.url?scp=0028944147&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028944147&partnerID=8YFLogxK

U2 - 10.1001/archinte.1995.00430060097012

DO - 10.1001/archinte.1995.00430060097012

M3 - Article

VL - 155

SP - 633

EP - 638

JO - JAMA Internal Medicine

JF - JAMA Internal Medicine

SN - 2168-6106

IS - 6

ER -