Empathy and Life Support Decisions in Intensive Care Units
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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.
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.
Multi-center, prospective study of audiotaped physician-family conferences in intensive care units of four hospitals in 2000–2002.
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.
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).
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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- Empathy and Life Support Decisions in Intensive Care Units
Journal of General Internal Medicine
Volume 23, Issue 9 , pp 1311-1317
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- surrogate decision-making
- life support
- Industry Sectors
- Author Affiliations
- 1. The Wright Institute, Berkeley, CA, USA
- 2. Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, Seattle, WA, USA
- 3. Division of Pulmonary and Critical Care Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
- 4. Program in Medical Ethics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA