Family caregivers who had not discussed life support measures with critically ill patients took nearly two weeks longer to decide to forego further medical intervention than those who had prior conversations about the issues, according to researchers from the University of Pittsburgh School of Medicine and the Graduate School of Public Health. They share their findings in a poster presentation at the Society of Critical Care Medicine congress this week in San Diego.
Also, a patient's loved ones were more confident about acting as
surrogate decision-makers when they perceived their communication with
intensive care physicians to be of high quality, said senior
investigator Douglas B. White, M.D., MAS., associate professor and
director of the Program on Ethics and Decision-Making in Critical
Illness, Department of Critical Care Medicine.
"This is the first evidence to suggest that how a doctor guides family
members through the foreign territory of critical illness may influence
their ability to act as a surrogate," he noted. "Teaching doctors to be
better communicators may be an important step in improving end-of-life
decisions for patients. The study also reinforces the value of patients,
families and friends having prior conversations about the end of life
so that they can feel comfortable with their decisions about medical
For the study, conducted at four intensive care units at the University
of California San Francisco Medical Center between 2005 and 2008, the
researchers surveyed 230 caregivers who were making decisions on behalf
of incapacitated patients on ventilators with greater than a 50 percent
chance of dying from their illnesses.
They found caregivers who hadn't had a prior conversation with patients
about treatment preferences were less confident about making decisions
and it took them 40 percent longer - 33 days versus 21 days - to decide
to discontinue life support.
"This prolongation of the dying process may not be in the best interest
of patients and it places an enormous burden on the health care system,"
Dr. White said. "Health care reform will provide incentives for formal
advance care planning between physicians and patients, such as the
completion of advance directives and living wills. Our findings indicate
that informal conversations between patients and their families may be
very important for both patient-centered decisions and the family's
comfort with the huge responsibility of being a surrogate."
The research team included Alyssa Majesko, M.D., of UPMC, and S. Hong
and Lisa Weissfeld, Ph.D., of the University of Pittsburgh Graduate
School of Public Health. The project was funded by the National
Institutes of Health.
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