Table 2 Barriers with regard to physicians' knowledge
Quality indicator no. a | Barriers with regard to physicians' knowledge |
|---|---|
General | • Insufficient physician training in communication about end-of-life issuesb [42] |
• Clinician reluctance to use opioids or sedatives because of concern about side effectsb [42] | |
• Lack of education in palliative medicineb [44] | |
1 | • Involvement of surgeons slows down decision-making because they do not understand patient’s situationc [21] |
2 | • Lack of communication skills of senior medical residents when interacting with colleaguesc [22] |
5 | • No familiarity with skilled and timely communicationc [26] |
10 | • Not taught how to recognize that a person is about to die, no awareness of the process of dyingc [21] |
• Unrealistic expectations by clinicians about patient prognosis or effectiveness of ICU treatmentb [42] | |
16 | • Physician uncertainty about the legal details of advance directivesb [38] |
• Physician lack of physician experience with advance directivesb [38] | |
21 | • Lack of familiarity to make a prognosisc [15] |
• Not knowing how to deal with `feeling helpless• with families pressuring ICU teams to withhold treatment or when family members are upset about aggressiveness of care provided to their unwilling loved onec [22] | |
• Uncertainty concerning the services provided by local hospice programs and whom to refer to hospicesb [44] | |
• No awareness of professional or local guidelines that related to provision of futile careb [31] | |
• Insufficient training in communication with patients and their familiesb [31] | |
• Lack of discussion of ethical issues in medical programmes; lack of knowledge of ethical issues concerning end-of-life decisionsb [48] | |
22 | • No familiarity with defining futility and how to communicate futility to patients and their familiesc [19] |
• No knowledge of management of critical illness by referring specialists; confounding factors in decision-makingc [21] | |
23 | • Conditioned that doing nothing or withdrawing treatment is not helping patientc [19] |
• No familiarity with legal framework regarding end-of-life decisions, wrong conception that law prohibits withdrawal of mechanical ventilationc [27],[36] | |
• No awareness of end-of-life care guidelinesc [27] | |
• Not being at ease in talking to patients and their families about limitations of therapyb [36] | |
• No familiarity with end-of-life decision-making (`good prognosis' and `give it a go'often said because of no familiarity with end-of-life decision-making)b [25] | |
• Insufficient clinician training in techniques for forgoing life-sustaining treatment without causing patient sufferingb [42] |