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Swedish intensivists' experiences and attitudes regarding end-of-life decisions

Journal article
Authors Anna Nordenskjöld Syrous
Anders Ågård
M. K. Redfors
Silvana Naredi
Linda Block
Published in Acta Anaesthesiologica Scandinavica
Pages 7
ISSN 0001-5172
Publication year 2020
Published at Institute of Clinical Sciences, Department of Anesthesiology and Intensive care
Institute of Medicine
Pages 7
Language en
Links dx.doi.org/10.1111/aas.13549
Keywords qualitative research, sustaining treatment, care units, variability, withdrawal, physicians, Anesthesiology
Subject categories Nursing, Anesthesiology and Intensive Care

Abstract

Background To make end-of-life (EOL) decisions is a complex and challenging task for intensive care physicians and a substantial variability in this process has been previously reported. However, a deeper understanding of intensivists' experiences and attitudes regarding the decision-making process is still, to a large extent, lacking. The primary aim of this study was to address Swedish intensivists' experiences, beliefs and attitudes regarding decision-making pertaining to EOL decisions. Second, we aimed to identify underlying factors that may contribute to variability in the decision-making process. Method This is a descriptive, qualitative study. Semi-structured interviews with nineteen intensivists from five different Swedish hospitals, with different ICU levels, were performed from 1 February 2017 to 31 May 2017. Results Intensivists strive to make end-of-life decisions that are well-grounded, based on sufficient information. Consensus with the patient, family and other physicians is important. Concurrently, decisions that are made with scarce information or uncertain medical prognosis, decisions made during on-call hours and without support from senior consultants cause concern for many intensivists. Underlying factors that contribute to the variability in decision-making are lack of continuity among senior intensivists, lack of needed support during on-call hours and disagreements with physicians from other specialties. There is also an individual variability primarily depending on the intensivist's personality. Conclusion Swedish intensivists' wish to make end-of-life decisions based on sufficient information, medically certain prognosis and consensus with the patient, family, staff and other physicians. Swedish intensivists' experience a variability in end-of-life decisions, which is generally accepted and not questioned.

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