Monthly Summaries of Nursing Research: January 2008

Medscape Nurses 

In This Article

Physicians Often Reluctant to Discuss Imminent Death With Critically Ill Patients

Sullivan AM, Lakoma MD, Matsuyama RK, Rosenblatt L, Arnold RM, Block SD. Diagnosing and discussing imminent death in the hospital: a secondary analysis of physician interviews. Journal of Palliative Medicine. 2007;10:882-893.

When clinicians are taking care of a critically ill patient, recognition of impending death is important; this knowledge can help clarify or change the goals of care, inform decision-making, and allow the patient and the family time to prepare. However, previous studies have shown that clinicians are often reluctant to discuss the likelihood of imminent death and related end-of-life issues with patients and their families.

A research team led by Amy M. Sullivan at the Dana-Farber Cancer Institute in Boston evaluated clinician communication with patients who were facing imminent death. For the study, the cases of 70 patients who died in the hospital were selected at random, and interviews were conducted with the physicians who treated those patients. The patients averaged 66 years of age, and 84% were white. In their last few days of life, 37% were lucid and talking, 35% had variable periods of lucidity, and 28% were unconscious. The patients had been admitted to either the intensive care unit or a general medicine unit. Because multiple physicians treated these patients, 196 physicians were interviewed in total.

For the study cases, 86% of the physicians reported becoming certain of the imminent death of the patient, often within days or hours of the event. However, the physicians informed fewer than half of the patients about the dire state of their condition, and only 11% reported personally discussing with the patient the possibility of dying. Physicians who talked with a patient about end-of-life issues reported feeling closer to the patient and were more satisfied with the care they provided than those who did not.

The results of the study indicate that physicians remain reluctant to raise the issue of dying with critically ill patients even when they recognize that death is imminent. Improving communications at this time could help enhance the sense of connection for clinicians and improve the delivery of end-of-life care.

Abstract

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