ABOUT LIFE-SUSTAINING TREATMENT - IMPACT OF PHYSICIANS BEHAVIORS ON THE FAMILY

Background: Despite the growing availability of advance directives, mo st patients in the intensive care unit lack written directives, and, t herefore, consultation with families about treatment decisions remains the rule. In the context of decision making about withdrawing life-su staining treatments, we investigated which physician and nurse behavio rs families find supportive and which behaviors increase the family's burden. Methods: We conducted intensive 1- to 2-hour-long individual i nterviews using a semistructured interview protocol with 32 family mem bers of patients without advance directives whose deaths followed a st ay in the intensive care unit and withdrawal of treatment. We analyzed more than 700 pages of verbatim interview data using content analysis techniques and achieved more than 90% interrater agreement on data co des. Results: Themes emerged as families identified selected physician and nursing behaviors as helpful: encouraging advanced planning, time ly communication, clarification of families' roles, facilitating famil y consensus, and accommodating family's grief. Behaviors that made fam ilies feel excluded or increased their burden included postponing disc ussions about treatment withdrawal, delaying withdrawal once scheduled , placing the full burden of decision making on one person, withdrawin g from the family, and defining death as a failure. Conclusions: Study findings provide an increased understanding of the unmet needs of fam ilies and serve to guide physicians and nurses in reducing actions tha t increase families' burdens as they participate in treatment withdraw al decisions.