Withholding or withdrawing life support in long-term neurointensive care patients: a single-centre, prospective, observational pilot study
| Autor: | Martin Koehnlein, Benjamin Hotter, Franziska Scheibe, Ulf Ziemann, Sarah Hoffmann, Annerose Mengel, Mihaly Sulyok, Robert Fleischmann, Andreas Meisel, Maria-Ioanna Stefanou |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Health (social science) Palliative care Intraclass correlation Decision Making Pilot Projects Disease 01 natural sciences 010104 statistics & probability 03 medical and health sciences 0302 clinical medicine Quality of life (healthcare) Arts and Humanities (miscellaneous) Humans Medicine Prospective Studies 030212 general & internal medicine 0101 mathematics Terminal Care business.industry Health Policy Neurointensive care Life Support Care Issues ethics and legal aspects Withholding Treatment Family medicine Life support Quality of Life Observational study business End-of-life care |
| Zdroj: | Journal of Medical Ethics. 48:50-55 |
| ISSN: | 1473-4257 0306-6800 |
| DOI: | 10.1136/medethics-2019-106027 |
| Popis: | PurposeScarce evidence exists regarding end-of-life decision (EOLD) in neurocritically ill patients. We investigated the factors associated with EOLD making, including the group and individual characteristics of involved healthcare professionals, in a multiprofessional neurointensive care unit (NICU) setting.Materials and methodsA prospective, observational pilot study was conducted between 2013 and 2014 in a 10-bed NICU. Factors associated with EOLD in long-term neurocritically ill patients were evaluated using an anonymised survey based on a standardised questionnaire.Results8 (25%) physicians and 24 (75%) nurses participated in the study by providing their ‘treatment decisions’ for 14 patients at several time points. EOLD was ‘made’ 44 (31%) times, while maintenance of life support 98 (69%) times. EOLD patterns were not significantly different between professional groups. The individual characteristics of the professionals (age, gender, religion, personal experience with death of family member and NICU experience) had no significant impact on decisions to forgo or maintain life-sustaining therapy. EOLD was patient-specific (intraclass correlation coefficient: 0.861), with the presence of acute life-threatening disease (OR (95% CI): 18.199 (1.721 to 192.405), p=0.038) and low expected patient quality of life (OR (95% CI): 9.276 (1.131 to 76.099), p=0.016) being significant and independent determinants for withholding or withdrawing life-sustaining treatment.ConclusionsOur findings suggest that EOLD in NICU relies mainly on patient prognosis and not on the characteristics of the healthcare professionals. |
| Databáze: | OpenAIRE |
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