Who is attending? End-of-life decision making in the intensive care unit

Judith Baggs, Madeline H. Schmitt, Thomas J. Prendergast, Sally A. Norton, Craig R. Sellers, Jill R. Quinn, Nancy Press

    Research output: Contribution to journalArticle

    17 Citations (Scopus)

    Abstract

    Purpose: Traditional expectations of the single attending physician who manages a patient's care do not apply in today's intensive care units (ICUs). Although many physicians and other professionals have adapted to the complexity of multiple attendings, ICU patients and families often expect the traditional, single physician model, particularly at the time of end-of-life decision making (EOLDM). Our purpose was to examine the role of ICU attending physicians in different types of ICUs and the consequences of that role for clinicians, patients, and families in the context of EOLDM. Methods: Prospective ethnographic study in a university hospital, tertiary care center. We conducted 7 months of observations including 157 interviews in each of four adult critical care units. Results: The term "attending physician" was understood by most patients and families to signify an individual accountable person. In practice, "the attending physician" was an ICU role, filled by multiple physicians on a rotating basis or by multiple physicians simultaneously. Clinicians noted that management of EOLDM varied in relation to these multiple and shifting attending responsibilities. The attending physician role in this practice context and in the EOLDM process created confusion for families and for some clinicians about who was making patient care decisions and with whom they should confer. Conclusions: Any intervention to improve the process of EOLDM in ICUs needs to reflect system changes that address clinician and patient/family confusion about EOLDM roles of the various attending physicians encountered in the ICU.

    Original languageEnglish (US)
    Pages (from-to)56-62
    Number of pages7
    JournalJournal of Palliative Medicine
    Volume15
    Issue number1
    DOIs
    StatePublished - Jan 1 2012

    Fingerprint

    Intensive Care Units
    Decision Making
    Physicians
    Patient Care
    Physician's Role
    Confusion
    Critical Care
    Tertiary Care Centers
    Prospective Studies
    Interviews

    ASJC Scopus subject areas

    • Medicine(all)
    • Anesthesiology and Pain Medicine
    • Nursing(all)

    Cite this

    Baggs, J., Schmitt, M. H., Prendergast, T. J., Norton, S. A., Sellers, C. R., Quinn, J. R., & Press, N. (2012). Who is attending? End-of-life decision making in the intensive care unit. Journal of Palliative Medicine, 15(1), 56-62. https://doi.org/10.1089/jpm.2011.0307

    Who is attending? End-of-life decision making in the intensive care unit. / Baggs, Judith; Schmitt, Madeline H.; Prendergast, Thomas J.; Norton, Sally A.; Sellers, Craig R.; Quinn, Jill R.; Press, Nancy.

    In: Journal of Palliative Medicine, Vol. 15, No. 1, 01.01.2012, p. 56-62.

    Research output: Contribution to journalArticle

    Baggs, J, Schmitt, MH, Prendergast, TJ, Norton, SA, Sellers, CR, Quinn, JR & Press, N 2012, 'Who is attending? End-of-life decision making in the intensive care unit', Journal of Palliative Medicine, vol. 15, no. 1, pp. 56-62. https://doi.org/10.1089/jpm.2011.0307
    Baggs, Judith ; Schmitt, Madeline H. ; Prendergast, Thomas J. ; Norton, Sally A. ; Sellers, Craig R. ; Quinn, Jill R. ; Press, Nancy. / Who is attending? End-of-life decision making in the intensive care unit. In: Journal of Palliative Medicine. 2012 ; Vol. 15, No. 1. pp. 56-62.
    @article{d1affb5382c445ae9939e41a319b6360,
    title = "Who is attending? End-of-life decision making in the intensive care unit",
    abstract = "Purpose: Traditional expectations of the single attending physician who manages a patient's care do not apply in today's intensive care units (ICUs). Although many physicians and other professionals have adapted to the complexity of multiple attendings, ICU patients and families often expect the traditional, single physician model, particularly at the time of end-of-life decision making (EOLDM). Our purpose was to examine the role of ICU attending physicians in different types of ICUs and the consequences of that role for clinicians, patients, and families in the context of EOLDM. Methods: Prospective ethnographic study in a university hospital, tertiary care center. We conducted 7 months of observations including 157 interviews in each of four adult critical care units. Results: The term {"}attending physician{"} was understood by most patients and families to signify an individual accountable person. In practice, {"}the attending physician{"} was an ICU role, filled by multiple physicians on a rotating basis or by multiple physicians simultaneously. Clinicians noted that management of EOLDM varied in relation to these multiple and shifting attending responsibilities. The attending physician role in this practice context and in the EOLDM process created confusion for families and for some clinicians about who was making patient care decisions and with whom they should confer. Conclusions: Any intervention to improve the process of EOLDM in ICUs needs to reflect system changes that address clinician and patient/family confusion about EOLDM roles of the various attending physicians encountered in the ICU.",
    author = "Judith Baggs and Schmitt, {Madeline H.} and Prendergast, {Thomas J.} and Norton, {Sally A.} and Sellers, {Craig R.} and Quinn, {Jill R.} and Nancy Press",
    year = "2012",
    month = "1",
    day = "1",
    doi = "10.1089/jpm.2011.0307",
    language = "English (US)",
    volume = "15",
    pages = "56--62",
    journal = "Journal of Palliative Medicine",
    issn = "1096-6218",
    publisher = "Mary Ann Liebert Inc.",
    number = "1",

    }

    TY - JOUR

    T1 - Who is attending? End-of-life decision making in the intensive care unit

    AU - Baggs, Judith

    AU - Schmitt, Madeline H.

    AU - Prendergast, Thomas J.

    AU - Norton, Sally A.

    AU - Sellers, Craig R.

    AU - Quinn, Jill R.

    AU - Press, Nancy

    PY - 2012/1/1

    Y1 - 2012/1/1

    N2 - Purpose: Traditional expectations of the single attending physician who manages a patient's care do not apply in today's intensive care units (ICUs). Although many physicians and other professionals have adapted to the complexity of multiple attendings, ICU patients and families often expect the traditional, single physician model, particularly at the time of end-of-life decision making (EOLDM). Our purpose was to examine the role of ICU attending physicians in different types of ICUs and the consequences of that role for clinicians, patients, and families in the context of EOLDM. Methods: Prospective ethnographic study in a university hospital, tertiary care center. We conducted 7 months of observations including 157 interviews in each of four adult critical care units. Results: The term "attending physician" was understood by most patients and families to signify an individual accountable person. In practice, "the attending physician" was an ICU role, filled by multiple physicians on a rotating basis or by multiple physicians simultaneously. Clinicians noted that management of EOLDM varied in relation to these multiple and shifting attending responsibilities. The attending physician role in this practice context and in the EOLDM process created confusion for families and for some clinicians about who was making patient care decisions and with whom they should confer. Conclusions: Any intervention to improve the process of EOLDM in ICUs needs to reflect system changes that address clinician and patient/family confusion about EOLDM roles of the various attending physicians encountered in the ICU.

    AB - Purpose: Traditional expectations of the single attending physician who manages a patient's care do not apply in today's intensive care units (ICUs). Although many physicians and other professionals have adapted to the complexity of multiple attendings, ICU patients and families often expect the traditional, single physician model, particularly at the time of end-of-life decision making (EOLDM). Our purpose was to examine the role of ICU attending physicians in different types of ICUs and the consequences of that role for clinicians, patients, and families in the context of EOLDM. Methods: Prospective ethnographic study in a university hospital, tertiary care center. We conducted 7 months of observations including 157 interviews in each of four adult critical care units. Results: The term "attending physician" was understood by most patients and families to signify an individual accountable person. In practice, "the attending physician" was an ICU role, filled by multiple physicians on a rotating basis or by multiple physicians simultaneously. Clinicians noted that management of EOLDM varied in relation to these multiple and shifting attending responsibilities. The attending physician role in this practice context and in the EOLDM process created confusion for families and for some clinicians about who was making patient care decisions and with whom they should confer. Conclusions: Any intervention to improve the process of EOLDM in ICUs needs to reflect system changes that address clinician and patient/family confusion about EOLDM roles of the various attending physicians encountered in the ICU.

    UR - http://www.scopus.com/inward/record.url?scp=84856301869&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=84856301869&partnerID=8YFLogxK

    U2 - 10.1089/jpm.2011.0307

    DO - 10.1089/jpm.2011.0307

    M3 - Article

    VL - 15

    SP - 56

    EP - 62

    JO - Journal of Palliative Medicine

    JF - Journal of Palliative Medicine

    SN - 1096-6218

    IS - 1

    ER -