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Empathy and Life Support Decisions in Intensive Care Units

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Abstract

Background

Although experts advocate that physicians should express empathy to support family members faced with difficult end-of-life decisions for incapacitated patients, it is unknown whether and how this occurs in practice.

Objectives

To determine whether clinicians express empathy during deliberations with families about limiting life support, to develop a framework to understand these expressions of empathy, and to determine whether there is an association between more empathic statements by clinicians and family satisfaction with communication.

Design

Multi-center, prospective study of audiotaped physician-family conferences in intensive care units of four hospitals in 2000–2002.

Measurements

We audiotaped 51 clinician-family conferences that addressed end-of-life decisions. We coded the transcripts to identify empathic statements and used constant comparative methods to categorize the types of empathic statements. We used generalized estimating equations to determine the association between empathic statements and family satisfaction with communication.

Main Results

There was at least one empathic statement in 66% (34/51) of conferences with a mean of 1.6 ± 1.6 empathic statements per conference (range 0–8). We identified three main types of empathic statements: statements about the difficulty of having a critically ill loved one (31% of conferences), statements about the difficulty of surrogate decision-making (43% of conferences), and statements about the difficulty of confronting death (27% of conferences). Only 30% of empathic statements were in response to an explicit expression of emotion by family members. There was a significant association between more empathic statements and higher family satisfaction with communication (p = 0.04).

Conclusions

Physicians vary considerably in the extent to which they express empathy to surrogates during deliberations about life support, with no empathic statements in one-third of conferences. There is an association between more empathic statements and higher family satisfaction with communication.

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Acknowledgments

None

Funding Information

This project was supported by NIH grants: (1) National Institute of Nursing Research RO1NR005226 (JRC and RAE) and (2) KL2 RR024130 from the National Center for Research Resources (NCRR), a component of the NIH Roadmap for Medical Research. (DBW).

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. The Wright Institute, Berkeley, CA, USA

    R. Brac Selph PsyD & Julia Shiang PhD

  2. Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, Seattle, WA, USA

    Ruth Engelberg PhD & J. Randall Curtis MD, MPH

  3. Division of Pulmonary and Critical Care Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA

    Douglas B. White MD, MAS

  4. Program in Medical Ethics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA

    Douglas B. White MD, MAS

Authors
  1. R. Brac Selph PsyD
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  2. Julia Shiang PhD
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  3. Ruth Engelberg PhD
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  4. J. Randall Curtis MD, MPH
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  5. Douglas B. White MD, MAS
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Corresponding author

Correspondence to Douglas B. White MD, MAS.

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Selph, R.B., Shiang, J., Engelberg, R. et al. Empathy and Life Support Decisions in Intensive Care Units. J GEN INTERN MED 23, 1311–1317 (2008). https://doi.org/10.1007/s11606-008-0643-8

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  • DOI: https://doi.org/10.1007/s11606-008-0643-8

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