Barriers to end-of-life decisions and care objectives in intensive care units

Abstract

Aims: Technological advancements have played a crucial role in the advanced development of organ support systems in intensive care units (ICUs). While the utilization of support systems enhances patient discharge rates, it also extends the ICU stay of patients with terminal comorbidities who have no chance of survival. This elongation of the dying process, which is the inevitable outcome, results in a suspension of life in a sense. Hence, the effective implementation of end-of-life decisions and care stands as one of the crucial steps in the intensive care process. The objective of this study is to identify barriers to end-of-life decision-making and care in intensive care settings. Its aim is to facilitate a comprehensive, suitable, and peaceful experience for patients at the end of life and their families by making the necessary arrangements. Methods: This survey study involved physicians and nurses evaluating the prepared questionnaire questions concerning the challenges encountered in intensive care settings. Results: The most important barriers to making end-of-life decisions in intensive care were; among clinician-related factors, concern about legal liability for withholding life-sustaining treatments was 98 (79.7%), among institutional and ICU-related factors, the lack of regulated protocols and standards for end-of-life decisions and care was 96 (78%), among family-related factors, unrealistic expectations of patients and/or families about the prognosis or effectiveness of ICU treatment was 83 (67.5%), and disagreements among family members about end-of-life decisions was 80 (65%).Regarding end-of-life care, the admission of patients to the intensive care unit who would not benefit from treatments in the intensive care unit was rated as 110 (89.4%) and the absence of palliative care services to which a dying patient could be transferred was rated as 108 (87.8%). Conclusion: Providing unavailing treatments to patients who will not benefit from intensive care interventions results in a decline in quality of life, increased distress among family members, and burnout among intensive care staff. Therefore, end-of-life decisions and care should be effectively implemented in intensive care units. Ensuring adequate training, fostering effective communication between clinicians and families, and maximizing collaboration and communication with the ICU team and other medical departments can facilitate prompt and effective decision-making regarding end-of-life care.