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. 1. Hadassah Hebrew University Medical Center and School of Nursing, Israel. Electronic address: 1julie@hadassah.org.il. 2. Hadassah Hebrew University School of Nursing and Jerusalem College of Technology, Israel. Electronic address: freda@jct.ac.il. 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: Matthew.Anstey@health.wa.gov.au. 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: catherine.ingels@kuleuven.be. 9. Intensive Care Medicine, Gabriel-Montpied University Hospital, Clermont-Ferrand, France. Electronic address: alautrette@chu-clermontferrand.fr. 10. Intensive Medicine Department, University Hospital La Paz, Madrid, Spain. 11. Urgent & Emergency Care Group, William Harvey Hospital, Ashford, Kent, UK. Electronic address: Cplowright@aol.com. 12. Intensive Care of Geneva, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva Hospital and University of Geneva, Switzerland. Electronic address: bararicou@bluewin.ch. 13. Department of Anesthesiology and Critical Care, Oslo University Hospital, Oslo, Norway. Electronic address: annrobe@online.no. 14. Department of Intensive Care, Hadassah Hebrew University Medical Center, Israel. Electronic address: sprung@cc.huji.ac.il.
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.
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.