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Communication of end-of-life decisions in European intensive care units

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Abstract

Objective

To examine end-of-life (EOL) practices in European ICUs: who makes these decisions, how they are made, communication of these decisions and questions on communication between the physicians, nurses, patients and families.

Design

Data collected prospectively on EOL decisions facilitated by a questionnaire including EOL decision categories, geographical regions, mental competency, information about patient wishes, and discussions with patients, families and health care professionals.

Setting

37 European ICUs in 17 countries

Patients

ICU physicians collected data on 4,248 patients.

Results

95% of patients lacked decision making capacity at the time of EOL decision and patient’s wishes were known in only 20% of cases. EOL decisions were discussed with the family in 68% of cases. Physicians reported having more information about patients’ wishes and discussions in the northern countries (31%, 88%) than central (16%, 70%) or southern (13%, 48%) countries. The family was more often told (88%) than asked (38%) about EOL decisions. Physicians’ reasons for not discussing EOL care with the family included the fact that the patient was unresponsive to therapy (39%), the family was unavailable (28%), and the family was thought not to understand (25%).

Conclusions

ICU patients typically lack decision-making capacity, and physicians know patients’ wishes in only 20% of EOL decisions. There were regional differences in discussions of EOL decisions with families and other physicians. In European ICUs there seems to be a need to improve communication

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Acknowledgements

The Ethicus Steering Committee: C. Sprung, S. Cohen, L. Epstein, D. Miranda, F. Lemaire, and G. Van Steendam. Participanting investigators and their affiliation are listed in Table 5.

Table 5 Participating investigators of the Ethicus study
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Author information

Authors and Affiliations

  1. Department of Medicine, University College London, London, UK

    Simon Cohen

  2. Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel

    Charles Sprung

  3. Department of Anesthesiology, Orebro University Hospital, Orebro, Sweden

    Peter Sjokvist

  4. Department of Anesthesiology, Herlev University Hospital, Herlev, Denmark

    Anne Lippert

  5. Hôpital Cantonal Universitaire de Geneve, Geneva, Switzerland

    Bara Ricou

  6. Hadassah School of Public Health, Hebrew University, Jerusalem, Israel

    Mario Baras

  7. Department of Anesthesiology, South Karelia Central Hospital, Lappeenranta, Finland

    Seppo Hovilehto

  8. Department of Intensive Care, Hospital Geral Santo Antonio, Porto, Portugal

    Paulo Maia

  9. Department of Intensive Care, Mater Hospital University College, Dublin, Ireland

    Dermot Phelan

  10. Department of Anesthesiology and Intensive Care Medicine, University Hospital Jena, Jena, Germany

    Konrad Reinhart

  11. Martin Luther University, Halle-Wittenberg, Halle, Germany

    Karl Werdan

  12. Department of Anesthesiology, University Hospital of Glostrup, Glostrup, Denmark

    Hans-Henrik Bulow

  13. Critical Care Directorate, Southampton University Hospitals NHS Trust, Southampton, UK

    Tom Woodcock

Authors
  1. Simon Cohen
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  2. Charles Sprung
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  3. Peter Sjokvist
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  4. Anne Lippert
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  5. Bara Ricou
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  6. Mario Baras
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  7. Seppo Hovilehto
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  8. Paulo Maia
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  9. Dermot Phelan
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  10. Konrad Reinhart
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  11. Karl Werdan
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  12. Hans-Henrik Bulow
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  13. Tom Woodcock
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Corresponding author

Correspondence to Simon Cohen.

Additional information

P. Sjokvist died in December 2003

Funding was provided by the European Concerted Action project and by the European Commission (contract PL963733), the Chief Scientist’s Office of the Ministry of Health, Israel (grant no. 4226), the European Society of Intensive Care Medicine (ESICM) and by OFES Switzerland (Biomed, no. 980271)

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Cohen, S., Sprung, C., Sjokvist, P. et al. Communication of end-of-life decisions in European intensive care units. Intensive Care Med 31, 1215–1221 (2005). https://doi.org/10.1007/s00134-005-2742-x

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  • DOI: https://doi.org/10.1007/s00134-005-2742-x

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