Limitation of life-support therapy in critically ill patients: family response and attitudes

Introduction and aim

Despite modern intensive therapy, 10-20% of patients admitted to ICU will not survive [1,2]. Dealing with family issues surrounding death is therefore an important aspect of ICU care. The purpose of this study was to record aspects of the experience of families whose relative had undergone LOT and identify the views of the family regarding who should be involved in the process of LOT.

Methods

Consent for a telephone interview and demographic data were obtained from the representative of all families whose relative had died in the ICU. Four weeks later, the representative was contacted for a structured telephone interview. Questions explored the respondents experience of anxiety related to the process of LOT, their understanding of the explanation and the reasons for LOT, and the adequacy of time to participate in the decision. Respondents were asked who should be involved in the decision process.

Results

The relatives of 88 patients who died were interviewed. Sixty-six (75%) patients had undergone LOT. The majority of respondents (90%) expressed that the explanation of LOT was clear and understood, but 18% felt pressurized into decision making, and 16% felt that inadequate time was allowed for discussion before the decision was made. Participating in the LOT decision provoked anxiety in 45% of respondents. However, when compared with respondents whose relatives did not undergo LOT, the expression of anxiety was lower (P < 0.01). Respondents indicated that LOT decisions should be made by the doctor and patient and/or family group (41%), family and/or patient alone (32%), or doctor alone (22%).

Discussion and conclusion

While most family members understand the process of LOT, it is still associated with significant anxiety. Allocating more time to the decision making process and improving communication techniques may be important. Family members believe that they should be part of the decision making process.