Changes in intensive care unit nurse involvement in end of life decision making between 1999 and 2016: Descriptive comparative study

Julie Benbenishty; Freda DeKeyser Ganz; Matthew H Anstey; Francisco Jose Barbosa-Camacho; Maria Grazia Bocci; Elif Ayşe Çizmeci; Knut Dybwik; Catherine Ingels; Alexandre Lautrette; Roberto Carlos Miranda-Ackerman; Belén Estebanez-Montiel; Catherine Plowright; Bara Ricou; Annette Robertsen; Charles L Sprung

doi:10.1016/j.iccn.2021.103138

Changes in intensive care unit nurse involvement in end of life decision making between 1999 and 2016: Descriptive comparative study

Intensive Crit Care Nurs. 2022 Feb:68:103138. doi: 10.1016/j.iccn.2021.103138. Epub 2021 Nov 5.

Authors

Julie Benbenishty¹, Freda DeKeyser Ganz², Matthew H Anstey³, Francisco Jose Barbosa-Camacho⁴, Maria Grazia Bocci⁵, Elif Ayşe Çizmeci⁶, Knut Dybwik⁷, Catherine Ingels⁸, Alexandre Lautrette⁹, Roberto Carlos Miranda-Ackerman⁴, Belén Estebanez-Montiel¹⁰, Catherine Plowright¹¹, Bara Ricou¹², Annette Robertsen¹³, Charles L Sprung¹⁴

Affiliations

¹ Hadassah Hebrew University Medical Center and School of Nursing, Israel. Electronic address: [email protected].
² Hadassah Hebrew University School of Nursing and Jerusalem College of Technology, Israel. Electronic address: [email protected].
³ Sir Charles Gairdner Hospital, Perth, Australia; School of Public Health, Curtin University, Perth, Australia; School of Medicine, University of Western Australia, Australia. Electronic address: [email protected].
⁴ Intensive Care Unit Hospital San Javier, University of Guadalajara, Guadalajara, Jalisco, Mexico.
⁵ Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁶ University of Toronto, Faculty of Medicine, Interdepartmental Division of Critical Care, Sunnybrook Health Sciences Centre, Toronto, Canada; Uludağ University, Faculty of Medicine, Department of Anesthesiology and Intensive Care, Bursa, Turkey.
⁷ Intensive Care Unit, Nordland Hospital, Bodø, Nord University, Bodø, Norway.
⁸ University Hospital Gasthuisberg Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, Herestraat 49, B-3000 Leuven, Belgium. Electronic address: [email protected].
⁹ Intensive Care Medicine, Gabriel-Montpied University Hospital, Clermont-Ferrand, France. Electronic address: [email protected].
¹⁰ Intensive Medicine Department, University Hospital La Paz, Madrid, Spain.
¹¹ Urgent & Emergency Care Group, William Harvey Hospital, Ashford, Kent, UK. Electronic address: [email protected].
¹² Intensive Care of Geneva, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva Hospital and University of Geneva, Switzerland. Electronic address: [email protected].
¹³ Department of Anesthesiology and Critical Care, Oslo University Hospital, Oslo, Norway. Electronic address: [email protected].
¹⁴ Department of Intensive Care, Hadassah Hebrew University Medical Center, Israel. Electronic address: [email protected].

PMID: 34750044
DOI: 10.1016/j.iccn.2021.103138

Abstract

Objective: Comparison of nurse involvement in end of life decision making in European countries participating in ETHICUS I- 1999 and ETHICUS II- 2015.

Methodology: This was a prospective observational study of 22 European ICUs included in the ETHICUS-II and I. Data were collected as per the ETHICUS-I and ETHICUS-II protocols. Four questions within the ETHICUS protocols related to nurse involvement in end of life decision making were analyzed. This is a comparison of changes in nurse involvement in end of life decisions from 1999 to 2015.

Setting: International e-based questionnaire completed by an intensive care clinician when an end of life decision was performed on any patient.

Subjects: Intensive care physicians and nurses, no interventions were performed.

Measurements: A 20 question survey was used to describe the decision making process, on what basis was the decision made, who was involved in the decision making process, and what precise decisions were made.

Results: A total of 4592 cases from 22 centres are included. While there was more agreement between nurses and physicians in ETHICUS-I compared to ETHICUS-I, fewer discussions with nurses occurred in ETHICUS-II. The frequency of end of life decisions that were discussed with nurses decreased in all three regions between ETHICUS-I and ETHICUS-II.

Conclusion: Based on the results of the current study, nurses should be further encouraged to increase their involvement in end of life decision-making, especially those in southern Europe.

Keywords: Decision making; End of life; Intensive care; Nurse involvement.

Publication types

Observational Study

MeSH terms

Critical Care
Death
Decision Making
Humans
Intensive Care Units
Terminal Care*