From Cure to Care –Constituting Successful Family Conference in ICU via Physician-Families’ Viewpoints

• Main Authors: Hou-Tai Chang, 張厚台
• Other Authors: Duan-Rung Chen
• Format: Others
• Language: zh-TW
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/c3c265

博士 === 國立臺灣大學 === 健康政策與管理研究所 === 106 === Abstract Background: Many patients admitted to intensive care unit (ICU) with unknown preferences, and families were required to act as surrogate to make the decision to continue or withdraw life-sustaining treatment (LST). Families communicated with physicians about the goals of care and prognosis in end-of-life family conferences (EOLFC) worked as a cornerstone of end-of-life communication. Little evidence in the past articulated the successful EOLFC and well described how families made the end-of-life decision. Objectives: The objective of this study was to constitute the successful end-of-life family conference through the lens of physician and families’ viewpoints, and explore the process of how families experienced during end-of-life care and how they made the end-of-life decision. Material and methods: Semi-structured interview were conducted to ICU physicians and families who had participated in EOLFC and had experiences of decision to withdraw/withhold life-sustaining treatment. The verbatim was analyzed with MAXQDA Ver12 and word cloud generator - Wordclouds. Results: Thirty-one ICU physicians and nine families were enrolled into the study with purposive sampling. The average age of physicians is 43.3 y/o and the average age of families is 48.2 y/o. Twenty-one physicians (67.6%) have 6 years’ or more experience in ICU. For non-cancer and critically-ill patients, physicians felt difficult to identify the status when patients approached end of life period. Most physicians supposed ICU end-of-life as multi-organ failure which responded poorly to time-limited trial and should be managed according to patients’ best interests. Ninety percent physicians considered poor dignity in patients with severely impaired consciousness, and prone to withdraw life sustaining treatment in such group. The opinion was more diverse in physicians who were asked about“Limited intensive care is a “slippery slope” that will lead to abuses”, which hint audit about LST is indicated. Eight families had experiences to withdraw LST after EOLFC. The process of decision to withdraw LST included stages as follows: Different families’ readiness, Turning points from cure to care, Stressed decision-making, Compassionate silence、connected、Reassurance and closure, and continued CARE ( Comfort, Accompany, Relief and empathetic support ). All families considered EOLFC important for them to make end-of-life decision and were satisfied about the process of LST withdrawal. Conclusions: In our study, we found EOLFC important to guide end-of-life decision in ICU. In addition to the structure and process of EOLFC, physicians and families should communicate well to achieve “shared decision-making” about end-of-life care.