respiratory support withdrawal in intensive care units families, physicians and nurses views on two hypothetical clinical scenarios呼吸支持撤军在重症监护病房的家庭,两个假想的临床医生和护士意见场景.pdfVIP

Fumis and Deheinzelin Critical Care 2010, 14:R235 /content/14/6/R235 RESEARCH Open Access Respiratory support withdrawal in intensive care units: families, physicians and nurses views on two hypothetical clinical scenarios Renata RL Fumis1*†, Daniel Deheinzelin2† Abstract Introduction: Evidence suggests that dying patients’ physical and emotional suffering is inadequately treated in intensive care units. Although there are recommendations regarding decisions to forgo life-sustaining therapy, deciding on withdrawal of life support is difficult, and it is also difficult to decide who should participate in this decision. Methods: We distributed a self-administered questionnaire in 13 adult intensive care units (ICUs) assessing the attitudes of physicians and nurses regarding end-of-life decisions. Family members from a medical-surgical ICU in a tertiary cancer hospital were also invited to participate. Questions were related to two hypothetical clinical scenarios, one with a competent patient and the other with an incompetent patient, asking whether the ventilator treatment should be withdrawn and about who should make this decision. Results: Physicians (155) and nurses (204) of 12 ICUs agreed to take part in this study, along with 300 family members. The vast majority of families (78.6%), physicians (74.8%) and nurses (75%) want to discuss end-of-life decisions with competent patients. Most of the physicians and nurses desire family involvement in end-of-life decisions. Physicians are more likely to propose withdrawal of the ventilator with competent patients than with incompetent patients (74.8% × 60.7%, P = 0.028). When the patient was incompetent, physicians (34.8%) were significantly less prone than nurses (23.0%) and families (14.7%) to propose decisions regarding withdrawal of the ventilator suppo