JTPM
Journal of Translational and Practical Medicine

Journal of Translational and Practical Medicine regularly publishes internationally qualified issues in the field of Medicine in the light of up-to-date information.

eISSN: 2822-5082
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Online Manuscript System

Index
Original Article
End-of-life decisions in the intensive care unit-exploring the knowledge and attitude of nurses and doctors: a national survey
Abstract
Aim: In our country, there is a growing awareness regarding end-of-life practices. It has become evident that treatments in intensive care to end-stage patients, instead of honoring their previously made end-of-life decisions, significantly diminishes patients’ overall quality of life. The aim of study is drawing attention to end-of-life decision practices and to evaluate the knowledge and attitudes of intensive care physicians and nurses, who are decisive in end-of-life decision-making practices. Methods: The study was planned as a multi-center, cross-sectional, descriptive questionnaire. There were 21 questions about demographic data, definitions, and end-of-life decisions. 259 of 760 intensive care physicians and nurses who filled out the questionnaire were included. Results: Two hundred and fifty-nine participants were included. The rate of decision for terminal sedation and euthanasia was differentiating according to intensive care experience. Participants’ knowledge was insufficient regarding withholding and withdrawal approaches. Intensive care physicians, and patients at the terminal stage of chronic disease were recommended as decision makers with the highest rate. Conclusion: In this study, it was determined that the participants' knowledge about end-of-life decision concepts was not sufficient, and their approaches were differentiating due to experience. It is considered that there is a need for education and standardization about end-of-life decision-making process.

Keywords : End-of-life decision, terminal period, knowledge

Download Article


1. Angus DC, Barnato AE, Linde-Zwirble WT, et al. Use of intensivecare at the end of life in the United States: an epidemiologicstudy. Crit Care Med. 2004;32(3):638-643. doi:10.1097/01.ccm.0000114816.62331.08
2. Faber-Langendoen K, Bartels DM. Process of forgoing life-sustaining treatment in a university hospital: an empirical study.Crit Care Med. 1992;20(5):570-577. doi:10.1097/00003246-199205000-00005
3. Aydoğdu M. Geriatrik olgularda pulmoner yoğun bakım.TürkiyeKlinikleri Göğüs Hastalıkları-Özel Konular. 2017;10(3):158-165.
4. Kabalak AA. Türkiye’de Palyatif Bakim; Güncel Gelişmeler,Gereksinimler.JARSS. 2014;22(3):121-123.
5. Bruera E, Billings JA, Lupu D, Ritchie CS; Academic PalliativeMedicine Task Force of the American Academy of Hospice andPalliative Medicine. AAHPM position paper: requirements forthe successful development of academic palliative care programs.J Pain Symptom Manage. 2010;39(4):743-755. doi:10.1016/j.jpainsymman.2010.02.001
6. Puchalski CM, Kilpatrick SD, McCullough ME, Larson DB. Asystematic review of spiritual and religious variables in PalliativeMedicine, American Journal of Hospice and Palliative Care,Hospice Journal, Journal of Palliative Care, and Journal of Painand Symptom Management. Palliat Support Care. 2003;1(1):7-13.doi:10.1017/s1478951503030128
7. Luce JM. The changing physician-patient relationship in criticalcare medicine under health care reform. Am J Respir Crit CareMed. 1994;150(1):266-270. doi:10.1164/ajrccm.150.1.8025762
8. Manalo MF. End-of-life decisions about withholding orwithdrawing therapy: medical, ethical, and religio-culturalconsiderations. Palliat Care. 2013;7:1-5. doi:10.4137/PCRT.S10796
9. Sprung CL, Cohen SL, Sjokvist P, et al. End-of-life practicesin European intensive care units: the Ethicus Study. JAMA.2003;290(6):790-797. doi:10.1001/jama.290.6.790
10. Ditillo BA. Should there be a choice for cardiopulmonaryresuscitation when death is expected? Revisiting an old ideawhose time is yet to come. J Palliat Med. 2002;5(1):107-116.doi:10.1089/10966210252785079
11. Ferrand E, Robert R, Ingrand P, Lemaire F; French LATAREA Group.Withholding and withdrawal of life support in intensive-care unitsin France: a prospective survey. French LATAREA Group. Lancet.2001;357(9249):9-14. doi:10.1016/s0140-6736(00)03564-9
12. Barnato AE, Berhane Z, Weissfeld LA, et al. Racial variationin end-of-life intensive care use: a race or hospital effect?.Health Serv Res. 2006;41(6):2219-2237. doi:10.1111/j.1475-6773.2006.00598.x
13. Esteban Andrés, Gordo F, Solsona L, et al. Withdrawing andwithholding life support in the intensive care unit: a Spanishprospective multi-center observational study.Intensive Care Med.2001;27:1744-9.
14. Sullivan AM, Lakoma MD, Block SD. The status of medicaleducation in end-of-life care: a national report. J Gen Intern Med.2003;18(9):685-695. doi:10.1046/j.1525-1497.2003.21215.x
15. Davidson KW, Hackler C, Caradine DR, McCord RS. Physicians'attitudes on advance directives. JAMA. 1989;262(17):2415-2419.
16. Scherer Y, Jezewski MA, Graves B, Wu YW, Bu X. Advancedirectives and end-of-life decision making: survey of critical carenurses' knowledge, attitude, and experience. Crit Care Nurse.2006;26(4):30-40.
17. Crego PJ, Lipp EJ. Nurses' knowledge of advance directives. Am JCrit Care. 1998;7(3):218-223.
18. Coffey A, McCarthy G, Weathers E, et al. Nurses' knowledgeof advance directives and perceived confidence in end-of-lifecare: a cross-sectional study in five countries. Int J Nurs Pract.2016;22(3):247-257. doi:10.1111/ijn.12417
19. Guven T, Sert G. Advance directives in Turkey's cultural context:examining the potential benefits for the implementation ofpatient rights. Bioethics. 2010;24(3):127-133. doi:10.1111/j.1467-8519.2009.01789.x
20. Rady MY, Johnson DJ. Admission to intensive care unit at the end-of-life: is it an informed decision?. Palliat Med. 2004;18(8):705-711. doi:10.1191/0269216304pm959oa
21. Gruenberg DA, Shelton W, Rose SL, Rutter AE, Socaris S, McGeeG. Factors influencing length of stay in the intensive care unit.Am J Crit Care. 2006;15(5):502-509.
22. Bach V, Ploeg J, Black M. Nursing Roles in End-of-Life DecisionMaking in Critical Care Settings. West J Nurs Res. 2009;31(4):496-512. doi:10.1177/0193945908331178
23. McMillen RE. End of life decisions: nurses perceptions, feelingsand experiences. Intensive Crit Care Nurs. 2008;24(4):251-259.doi:10.1016/j.iccn.2007.11.002
24. Australian and New Zealand Intensive Care Society (ANZICS).ANZICS Statement on care and decision-making at the end of lifefor the critically ill. 2014.
25. Ahrens T, Yancey V, Kollef M. Improving family communicationsat the end of life: implications for length of stay in the intensivecare unit and resource use. Am J Crit Care. 2003;12(4):317-324.
26. Adams JA, Bailey DE Jr, Anderson RA, Docherty SL. Nursingroles and strategies in end-of-life decision making in acutecare: a systematic review of the literature. Nurs Res Pract.2011;2011:527834. doi:10.1155/2011/527834
Article available in :
Volume 2, Issue 2, 2023
Page : 69-73
https://doi.org/10.51271/JTPM-0044
Article Information
Received : 14 Ağu 2023
Accepted : 31 Ağu 2023
Published : 31 Ağu 2023
Corresponding Author :

Özlem Özkan Kuşcu: Baskent University, Faculty of Medicine, Department of Anaesthesiology and Reanimation, Adana, Turkey

[email protected]
Citation : Özkan Kuşcu Ö, Özcengiz D. End-of-life decisions in the intensive care unit-exploring the knowledge and attitude of nurses and doctors: a national survey. J Transl Pract Med. 2023;2(2):69-73.

Read: 224
Cited: 0
Download : 95
_Footer