End of life care in Brazil the long and winding road.docVIP

Soares Critical Care 2011,15:110 /content/15/1/110 COMMENTARY End of life care in Brazil: the long and winding road Márcio Soares* 1,2 See related research by Fumis and Deheinzelin, /content/14/6/R235 e results of the above mentioned study have potential Abstract implications, as disagreements between the perceptions of nurses and physicians regarding EOL decisions are common [2], and many ICU patients lack the capacity to participate in discussions and make decisions about their diagnosis, proposed treatments, and prognosis. When a patient is unable to make decisions, family members are automatically turned to as surrogates to decide and consent for advanced therapeutic interventions and for EOL decisions. However, family members are frequently unaware of patients’ wishes and preferences in the case of critical illness. Gaps in communication, disregarding families’ and patients’ preferences, and disagreements in expectancies at the EOL are well-known sources of con? icts with devastating consequences for healthcare workers, patients and family members, such as burnout, depression, anxiety and post-traumatic stress disorders Disagreements between the perceptions of nurses and physicians regarding end-of-life (EOL) decisions are frequent. In a survey carried out in 13 Brazilian ICUs, Fumis and Deheinzelin reported that the majority of nurses, physicians and family members are in favor of limiting life-sustaining therapies in terminally ill patients and that such decisions should involve the ICU team, patients and family members. However, they also observed signi?cant di?erences among the attitudes when faced with an incompetent patient. The present commentary evaluates the potential implications of the study results, contextualizing with the current scenario surrounding EOL care in Brazil. In a recent issue of Critical Care, Fumis and Deheinzelin [3-6]. In addition, con? icts at the EOL ar