Patients' and Surrogates' Decision-Making Characteristics Withdrawing, Withholding, and Continuing Life-Sustaining Treatments

    Authors

    L. W. Melhado;J. F. Byers

    Comments

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    Abbreviated Journal Title

    J. Hosp. Palliat. Nurs.

    Keywords

    advance planning; end-of-life decision-making and communication; medical; futility; withdrawing or withholding life-sustaining treatment; HEALTH-CARE PROVIDERS; INTENSIVE-CARE; HOSPITALIZED-PATIENTS; END; SUPPORT; FAMILIES; FUTILE; DEATH; ICU; COMMUNICATION; Nursing

    Abstract

    This integrated literature review examined clinically relevant evidence and provides insight regarding characteristics of patients and surrogates who withdraw or withhold life-sustaining treatment when faced with end-of-life, decision-making, or medically futile treatment compared with those who continue life-sustaining treatment against clinicians' recommendations. Spiraling healthcare costs and propensity to prolong life in the chronically and critically ill have spurred national debate of end-of-life care in the older adult population. Given the challenges associated with longevity, evaluation of current care practices and research are needed to determine best practice to improve communication for a diverse group with differences in culture, ethnicity, education, language, and family systems that influence decision making at end-of-life. Inclusion and exclusion parameters guided the review; databases searched were CINAHL, MEDLINE, PubMed, PsychINFO, and Cochrane Database of Systematic Reviews. Limits included studies from 1995 to 2010, English language and peer reviewed, yielding 19 articles that met the inclusion criteria and answered the research question. Several characteristics were extracted from the study results and clustered into topics. Awareness of patients' and surrogates' decision-making characteristics and communication styles can help clinicians identify potential barriers and variations in patterns of communication. Initial and ongoing assessments of patients' and surrogates' communication style and characteristics must be incorporated into the plan of care. Knowledge of key decision-making characteristics can be useful in role playing and education for clinicians in the health profession.

    Journal Title

    Journal of Hospice & Palliative Nursing

    Volume

    13

    Issue/Number

    1

    Publication Date

    1-1-2011

    Document Type

    Article

    Language

    English

    First Page

    16

    Last Page

    28

    WOS Identifier

    WOS:000285912600003

    ISSN

    1522-2179

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