title: Families looking back: one year after discussion of withdrawal or withholding of life-sustaining support.
abstract: OBJECTIVE
  To identify critical psychosocial supports and areas of conflict for families of intensive care unit (ICU) patients during decisions to withdraw or withhold life-sustaining treatment.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Six intensive care units in a tertiary care academic medical center.
  
  
  METHODS
  Forty-eight family members, one per case, of patients previously hospitalized in the ICU who had been considered for withdrawal or withholding of life-sustaining treatment.
  
  
  METHODS
  None.
  
  
  RESULTS
  Two raters coded transcripts of audiotaped interviews with family members about their experiences in the ICU and the decision-making process for withdrawing or withholding life-sustaining treatment. Codes identified sources of conflict and personal, institutional, and staff supports on which families relied during the decision-making process. Forty-six percent of respondents perceived conflict during their family member's ICU stay; the vast majority of conflicts were between themselves and the medical staff and involved communication or perceived unprofessional behavior (such as disregarding the primary caregiver in treatment discussions). Sixty-three percent of family members previously had spoken with the patient about his or her end-of-life treatment preferences, which helped to lessen the burden of the treatment decision. Forty-eight percent of family members reported the reassuring presence of clergy, and 27% commented on the need for improved physical space to have family discussion and conferences with physicians. Forty-eight percent of family members singled out their attending physician as the preferred source of information and reassurance.
  
  
  CONCLUSIONS
  Many families perceived conflict during end-of-life treatment discussions in the ICU. Conflicts centered on communication and behavior of staff. Families identified pastoral care and prior discussion of treatment preferences as sources of psychosocial support during these discussions. Families sought comfort in the identification and contact of a "doctor-in-charge." ICU policies such as family conference rooms and lenient visitation accommodate families during end-of-life decision-making.
authors.affiliation: Program on the Medical Encounter and Palliative Care, Durham VA Medical Center, NC, USA.
authors.forename: K H
authors.initials: KH
authors.lastname: Abbott
authors.forename: J G
authors.initials: JG
authors.lastname: Sago
authors.forename: C M
authors.initials: CM
authors.lastname: Breen
authors.forename: A P
authors.initials: AP
authors.lastname: Abernethy
authors.forename: J A
authors.initials: JA
authors.lastname: Tulsky
mesh_terms: D000328:Adult; D003144:Communication Barriers; D003220:Conflict, Psychological; D003430:Cross-Sectional Studies; D003657:Decision Making; D005066:Euthanasia, Passive; D005190:Family / Q000523:psychology*; D005260:Female; D006272:Health Facility Environment; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D011368:Professional-Family Relations; D012944:Social Support