Intensive Care Medicine

, Volume 31, Issue 9, pp 1215–1221

Communication of end-of-life decisions in European intensive care units

  • Simon Cohen
  • Charles Sprung
  • Peter Sjokvist
  • Anne Lippert
  • Bara Ricou
  • Mario Baras
  • Seppo Hovilehto
  • Paulo Maia
  • Dermot Phelan
  • Konrad Reinhart
  • Karl Werdan
  • Hans-Henrik Bulow
  • Tom Woodcock
Original

DOI: 10.1007/s00134-005-2742-x

Cite this article as:
Cohen, S., Sprung, C., Sjokvist, P. et al. Intensive Care Med (2005) 31: 1215. doi:10.1007/s00134-005-2742-x

Abstract

Objective

To examine end-of-life (EOL) practices in European ICUs: who makes these decisions, how they are made, communication of these decisions and questions on communication between the physicians, nurses, patients and families.

Design

Data collected prospectively on EOL decisions facilitated by a questionnaire including EOL decision categories, geographical regions, mental competency, information about patient wishes, and discussions with patients, families and health care professionals.

Setting

37 European ICUs in 17 countries

Patients

ICU physicians collected data on 4,248 patients.

Results

95% of patients lacked decision making capacity at the time of EOL decision and patient’s wishes were known in only 20% of cases. EOL decisions were discussed with the family in 68% of cases. Physicians reported having more information about patients’ wishes and discussions in the northern countries (31%, 88%) than central (16%, 70%) or southern (13%, 48%) countries. The family was more often told (88%) than asked (38%) about EOL decisions. Physicians’ reasons for not discussing EOL care with the family included the fact that the patient was unresponsive to therapy (39%), the family was unavailable (28%), and the family was thought not to understand (25%).

Conclusions

ICU patients typically lack decision-making capacity, and physicians know patients’ wishes in only 20% of EOL decisions. There were regional differences in discussions of EOL decisions with families and other physicians. In European ICUs there seems to be a need to improve communication

Keywords

End-of-life decisions Europe Intensive care units Patient competency Patient families Regional differences 

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Simon Cohen
    • 1
  • Charles Sprung
    • 2
  • Peter Sjokvist
    • 3
  • Anne Lippert
    • 4
  • Bara Ricou
    • 5
  • Mario Baras
    • 6
  • Seppo Hovilehto
    • 7
  • Paulo Maia
    • 8
  • Dermot Phelan
    • 9
  • Konrad Reinhart
    • 10
  • Karl Werdan
    • 11
  • Hans-Henrik Bulow
    • 12
  • Tom Woodcock
    • 13
  1. 1.Department of MedicineUniversity College LondonLondonUK
  2. 2.Department of Anesthesiology and Critical Care MedicineHadassah Hebrew University Medical CenterJerusalemIsrael
  3. 3.Department of AnesthesiologyOrebro University HospitalOrebroSweden
  4. 4.Department of AnesthesiologyHerlev University HospitalHerlevDenmark
  5. 5.Hôpital Cantonal Universitaire de GeneveGenevaSwitzerland
  6. 6.Hadassah School of Public HealthHebrew UniversityJerusalemIsrael
  7. 7.Department of AnesthesiologySouth Karelia Central Hospital LappeenrantaFinland
  8. 8.Department of Intensive CareHospital Geral Santo AntonioPortoPortugal
  9. 9.Department of Intensive CareMater Hospital University CollegeDublinIreland
  10. 10.Department of Anesthesiology and Intensive Care MedicineUniversity Hospital JenaJenaGermany
  11. 11.Martin Luther UniversityHalle-WittenbergHalleGermany
  12. 12.Department of AnesthesiologyUniversity Hospital of GlostrupGlostrupDenmark
  13. 13.Critical Care DirectorateSouthampton University Hospitals NHS TrustSouthamptonUK

Personalised recommendations