Conflict associated with decisions to limit life-sustaining treatment in intensive care units

OBJECTIVE: To determine the incidence and nature of interpersonal conflicts that arise when patients in the intensive care unit are considered for lim itation of life-sustaining treatment. DESIGN: Qualitative analysis of prospectively gathered interviews. SETTING: Six intensive care units at a university medical center. PARTICIPANTS: Semistructured interviews addressed disagreement during life- sustaining treatment decision making. Two raters coded transcripts of the a udiotaped interviews. MAIN RESULTS: At least 1 health care provider in 78% of the cases described a situation coded as conflict. Conflict occurred between the staff and fam ily members in 48% of the cases, among staff members in 48%, and among fami ly members in 24%. In 63% of the cases, conflict arose over the decision ab out life-sustaining treatment itself. In 45% of the cases, conflict occurre d over other tasks such as communication and pain control. Social issues ca used conflict in 19% of the cases. CONCLUSIONS: Conflict is more prevalent in the setting of intensive care de cision making than has previously been demonstrated. While conflict over th e treatment decision itself is most common, conflict over other issues, inc luding social issues, is also significant. By identifying conflict and by r ecognizing that the treatment decision may not be the only conflict present , or even the main one, clinicians may address conflict more constructively .