Monika C Kerckhoffs1, Matthijs Kant2, Johannes J M van Delden3, Lotty Hooft4, Jozef Kesecioglu5, Diederik van Dijk6. 1. Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands. Electronic address: m.c.kerckhoffs-2@umcutrecht.nl. 2. Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands. Electronic address: matthijs.kant1@gmail.com. 3. Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands. Electronic address: J.J.M.vanDelden@umcutrecht.nl. 4. Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands. Electronic address: L.Hooft@umcutrecht.nl. 5. Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands. Electronic address: J.kesecioglu@umcutrecht.nl. 6. Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands. Electronic address: D.vanDijk@umcutrecht.nl.
Abstract
PURPOSE: Many patients in the Intensive Care Unit (ICU) die after a decision to withhold or withdraw treatment. To ensure that for each patient the appropriate decision is taken, a careful decision-making process is required. This review identifies strategies that can be used to optimize the decision-making process for continuing versus limiting life sustaining treatment of ICU patients. METHODS: We conducted a systematic review of the literature by searching PUBMED and EMBASE. RESULTS: Thirty-two studies were included, with five categories of decision-making strategies (1) integrated communication, (2) consultative communication, (3) ethics consultation, (4) palliative care consultation and (5) decision aids. Many different outcome measures were used and none of them covered all aspects of decisions on continuing versus limiting life sustaining treatment. Integrated communication strategies had a positive effect on multiple outcome measures. Frequent, predefined family-meetings as well as triggered and integrated ethical or palliative consultation were able to reduce length of stay of patients who eventually died, without increasing overall mortality. CONCLUSIONS: The decision-making process in the ICU can be enhanced by frequent family-meetings with predefined topics. Ethical and palliative support is useful in specific situations. These interventions can reduce non-beneficial ICU treatment days.
PURPOSE: Many patients in the Intensive Care Unit (ICU) die after a decision to withhold or withdraw treatment. To ensure that for each patient the appropriate decision is taken, a careful decision-making process is required. This review identifies strategies that can be used to optimize the decision-making process for continuing versus limiting life sustaining treatment of ICU patients. METHODS: We conducted a systematic review of the literature by searching PUBMED and EMBASE. RESULTS: Thirty-two studies were included, with five categories of decision-making strategies (1) integrated communication, (2) consultative communication, (3) ethics consultation, (4) palliative care consultation and (5) decision aids. Many different outcome measures were used and none of them covered all aspects of decisions on continuing versus limiting life sustaining treatment. Integrated communication strategies had a positive effect on multiple outcome measures. Frequent, predefined family-meetings as well as triggered and integrated ethical or palliative consultation were able to reduce length of stay of patients who eventually died, without increasing overall mortality. CONCLUSIONS: The decision-making process in the ICU can be enhanced by frequent family-meetings with predefined topics. Ethical and palliative support is useful in specific situations. These interventions can reduce non-beneficial ICU treatment days.
Authors: M Á Ballesteros Sanz; A Hernández-Tejedor; Á Estella; J J Jiménez Rivera; F J González de Molina Ortiz; A Sandiumenge Camps; P Vidal Cortés; C de Haro; E Aguilar Alonso; L Bordejé Laguna; I García Sáez; M Bodí; M García Sánchez; M J Párraga Ramírez; R M Alcaraz Peñarrocha; R Amézaga Menéndez; P Burgueño Laguía Journal: Med Intensiva (Engl Ed) Date: 2020-04-08
Authors: Monika C Kerckhoffs; Jannien Senekal; Diederik van Dijk; Antonio Artigas; Jenie Butler; Andrej Michalsen; Margo M C van Mol; Rui Moreno; Filipa Pais da Silva; Edoardo Picetti; Pedro Póvoa; Annette Robertsen; Johannes J M van Delden Journal: Crit Care Med Date: 2020-05 Impact factor: 7.598