End-of-life decision making in the intensive care unit: physician and nurse perspectives

Abstract

End-of-life decision making, including consideration of advance directives and code status, is taking place more frequently in critical care units. There is a need to identify how nurses and physicians perceive end-of-life care so that nurse-physician understanding and communication can be improved. A total of 96 physicians and nurses completed a survey about their general beliefs and practices related to end-of-life care in the intensive care unit. Nurses were more likely to ask if there was a living will and to read it. Only 53% of physicians read living wills; however 90% of physicians consider the wishes in the living will when making recommendations to the family. Physicians were more likely to discuss do-not-resuscitate (DNR) orders only when a prognosis was poor. Family dynamics and medical/legal concerns most often affect decisions to obtain/write a DNR order for a critically ill patient. Suggested approaches for improving physician and nurse collaboration about end-of-life decision making are discussed.