Empathy and Life Support Decisions in Intensive Care Units

  • R. Brac Selph
  • Julia Shiang
  • Ruth Engelberg
  • J. Randall Curtis
  • Douglas B. White
Article

DOI: 10.1007/s11606-008-0643-8

Cite this article as:
Selph, R.B., Shiang, J., Engelberg, R. et al. J GEN INTERN MED (2008) 23: 1311. doi:10.1007/s11606-008-0643-8

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.

KEY WORDS

surrogate decision-making empathy life support communication 

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • R. Brac Selph
    • 1
  • Julia Shiang
    • 1
  • Ruth Engelberg
    • 2
  • J. Randall Curtis
    • 2
  • Douglas B. White
    • 3
    • 4
  1. 1.The Wright InstituteBerkeleyUSA
  2. 2.Division of Pulmonary and Critical Care MedicineHarborview Medical CenterSeattleUSA
  3. 3.Division of Pulmonary and Critical Care Medicine, University of CaliforniaSan Francisco School of MedicineSan FranciscoUSA
  4. 4.Program in Medical Ethics, Department of MedicineUniversity of California, San FranciscoSan FranciscoUSA

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