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Table 4 Barriers with respect to physicians' practice

From: Physician-related barriers to communication and patient- and family-centred decision-making towards the end of life in intensive care: a systematic review

Quality indicator no. a Barriers with respect to physicians' practice
General • Competing demands for clinicians' timeb [42]
1 • Unavailability of attending physicians due to rotation systemsc [22]
2 • Hierarchy under physicians is a barrier to their solving problems within the team before talking to the patientc [22]
• Individual physicians' lack of holistic viewsc [26]
7 • Physicians do not routinely check that family members understand the information they are given and do not discuss the family’s role in decision-makingc [29]
10 • Low confidence in taking responsibility; physicians do not refer patients to hospice care, because the patient or the patient’s family does not accept that the patient is dyingb [44]
15 • Not actively recommending the creation of an advance directiveb [38]
21 • Low confidence in taking responsibility; the physician does not take responsibility for collaborative decision-making with the dying patient and thus leaves the patient to die as if the patient has decided when to diec [15]
• Low confidence in taking responsibility; the physician considers family requests for continued futile treatment as a mandate and not as part of a normal communication and decision-making processc [17],[31]
• Low confidence in taking responsibility; the physician externalizes control of decision-making to patients, their families and specialists, who they believe expect aggressive treatmentc [17]
• Postponing decision-making until all treatment options are exhausted, until the last moment (surgeons)c [28]
• No use of professional or local guidelines related to the provision of futile careb [31]
23 • Lack of time and information are reasons to initiate life support, resulting in futile treatmentc [26]
• Continuation of aggressive treatment is justified, because of lot of money is already invested in the patient, and availability of resourcesc [17]
• Aggressive care deemed to be appropriate because of no awareness among providers of existence of advance directive or living willb [16]
• Low confidence in taking responsibility; the rate of withholding and withdrawing therapy was reduced based upon family’s wishesb [35]
• Considering withholding and withdrawing decisions inappropriately delayedb [37]
• No support of an internal multidisciplinary committee or professional policies in cases involving patients who do not have decision-making capacity or a surrogateb [43]
• Low confidence in taking responsibility; when the patient’s family insists that everything should be done for a patient with a poor prognosis, physicians are less inclined to withdraw treatment than when the family insists on limitation of therapyb [48]
• Low confidence in taking responsibility; high hopes of the family and their consistent requests to the surgeons contribute to the continuation of therapy which was considered futile by at least two consultantsb [49]
  1. aQuality indicators for adequate communication and decision-making in ICU as developed by Clarke and colleagues [11] and as outlined above in the Introduction. bBarriers for which weak evidence was found. cBarriers for which medium-quality evidence was found.