Intensive Care Medicine

, Volume 39, Issue 6, pp 1009–1018

Factors that contribute to physician variability in decisions to limit life support in the ICU: a qualitative study

  • Michael E. Wilson
  • Lori M. Rhudy
  • Beth A. Ballinger
  • Ann N. Tescher
  • Brian W. Pickering
  • Ognjen Gajic
Original

DOI: 10.1007/s00134-013-2896-x

Cite this article as:
Wilson, M.E., Rhudy, L.M., Ballinger, B.A. et al. Intensive Care Med (2013) 39: 1009. doi:10.1007/s00134-013-2896-x

Abstract

Purpose

Our aim was to explore reasons for physician variability in decisions to limit life support in the intensive care unit (ICU) utilizing qualitative methodology.

Methods

Single center study consisting of semi-structured interviews with experienced physicians and nurses. Seventeen intensivists from medical (n = 7), surgical (n = 5), and anesthesia (n = 5) critical care backgrounds, and ten nurses from medical (n = 5) and surgical (n = 5) ICU backgrounds were interviewed. Principles of grounded theory were used to analyze the interview transcripts.

Results

Eleven factors within four categories were identified that influenced physician variability in decisions to limit life support: (1) physician work environment—workload and competing priorities, shift changes and handoffs, and incorporation of nursing input; (2) physician experiences—of unexpected patient survival, and of limiting life support in physician’s family; (3) physician attitudes—investment in a good surgical outcome, specialty perspective, values and beliefs; and (4) physician relationship with patient and family—hearing the patient’s wishes firsthand, engagement in family communication, and family negotiation.

Conclusions

We identified several factors which physicians and nurses perceived were important sources of physician variability in decisions to limit life support. Ways to raise awareness and ameliorate the potentially adverse effects of factors such as workload, competing priorities, shift changes, and handoffs should be explored. Exposing intensivists to long term patient outcomes, formalizing nursing input, providing additional training, and emphasizing firsthand knowledge of patient wishes may improve decision making.

Keywords

Intensive careLife support careWithholding treatmentDecision makingPhysician’s roleTerminal care

Supplementary material

134_2013_2896_MOESM1_ESM.doc (40 kb)
Supplementary material 1 (DOC 40 kb)

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  • Michael E. Wilson
    • 1
  • Lori M. Rhudy
    • 2
    • 3
  • Beth A. Ballinger
    • 4
  • Ann N. Tescher
    • 2
  • Brian W. Pickering
    • 5
  • Ognjen Gajic
    • 6
  1. 1.Department of Internal MedicineMayo ClinicRochesterUSA
  2. 2.Department of NursingMayo ClinicRochesterUSA
  3. 3.University of Minnesota School of NursingMinneapolisUSA
  4. 4.Department of SurgeryMayo ClinicRochesterUSA
  5. 5.Department of Anesthesia and Critical Care MedicineMayo ClinicRochesterUSA
  6. 6.Divisions of Pulmonary and Critical Care Medicine, Department of Internal MedicineMayo ClinicRochesterUSA