COMMENTARY

Monthly Summaries of Nursing Research: December, 2008

January 05, 2009

Family Experiences During the Process of Withdrawal of Life-Sustaining Therapy

Wiegand D. In their own time: the family experience during the process of withdrawal of life-sustaining therapy. J Palliat Med. 2008;11:1115-1121.

Withdrawal of life-sustaining therapy (LST) commonly occurs in critical care units, yet little is known about the family experiences that occur during this difficult decision-making process. Nineteen families were followed as they participated in the process of withdrawal of LST from a family member with an unexpected, life-threatening illness or injury. Information on the decision-making process was gathered from multiple family members through a series of interviews and observations as families interacted with the patient and each other. Most family members were adults (57.1%), female (66%), and of white, non-Hispanic origin (89.3%). Approximately 52% of the patients had advance directives and most were older adults (mean age 63, range 20-82).

The investigators found that 90% of the families agreed with the healthcare provider's recommendation to withdraw LST (primarily mechanical ventilation, vasopressor therapy, or both). However, their experience in the process of withdrawal of LST happened "in their own time" and centered on a number of themes, including an understanding of the severity of the illness or injury, time required to see if health would be restored/waiting for a miracle, and family readiness/willingness to consider/decide on withdrawal of LST.

The insights provided by this study offer a unique view of what families experience as they participate in the difficult decision-making process of withdrawal of LST. Families tend to make withdrawal of LST decisions through a consensus process realizing the intensity and the enormity of their final decision. Time given to make this decision was especially important as the patient's illness or injury was often sudden, unexpected, and involved uncertainty. Acknowledging family feelings, and providing ongoing communication, support, and information to families are important interventions that healthcare providers should provide to assist families during the process of withdrawal of LST.

Abstract

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