ABSTRACT
The aim of this study was to evaluate agreement between nurses' and physicians' opinions regarding aggressiveness of treatment and to investigate and compare the rationales on which their opinions were based. Structured interviews regarding 714 patients were performed on seven general wards of a university hospital. The data gathered were then subjected to qualitative and quantitative analyses. There was 86% agreement between nurses' and physicians' opinions regarding full or limited treatment when the answers given as 'uncertain' were excluded. Agreement was less (77%) for patients with a life expectancy of less than one year. Disagreements were not associated with professional status because the physicians considered limiting life-sustaining treatment as often as the nurses. A broad spectrum of rationales was given but the results focus mostly on those for full treatment. The nurses and the physicians had similar bases for their opinions. For the majority of the patients, medical rationales were used, but age and quality of life were also expressed as important determinants. When considering full treatment, nurses used quality-of-life rationales for significantly more patients than the physicians. Respect for patients' wishes had a minor influence.
Subject(s)
Attitude of Health Personnel , Dissent and Disputes , Life Support Care/methods , Medical Staff, Hospital/psychology , Nursing Staff, Hospital/psychology , Terminal Care/methods , Age Factors , Cooperative Behavior , Decision Making , Female , Hospitals, University , Humans , Life Support Care/psychology , Male , Medical Futility , Nursing Methodology Research , Patient Participation/psychology , Patient Selection , Physician-Nurse Relations , Prognosis , Qualitative Research , Quality of Life , Surveys and Questionnaires , Sweden , Terminal Care/psychology , Withholding TreatmentABSTRACT
OBJECTIVE: To study how physicians from the admitting department reason during the decision-making process to forego life-sustaining treatment of patients in intensive care units (ICUs). DESIGN: Qualitative interview that applies a phenomenological approach. SETTING: Two ICUs at one secondary and one tertiary referral hospital in Sweden. PARTICIPANTS: Seventeen admitting-department physicians who have participated in decisions to forego life-sustaining treatment. RESULTS: The decision-making process as it appeared from the physicians' experiences was complex, and different approaches to the process were observed. A pattern of five phases in the process emerged in the interviews. The physicians described the process principally as a medical one, with few ethical reflections. Decision-making was mostly done in collaboration with other physicians. Patients, family and nurses did not seem to play a significant role in the process. CONCLUSION: This study describes how physicians reasoned when confronted with real patient situations in which decisions to forego life-sustaining treatment were mainly based on medical--not ethical--considerations.
