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 limitation of life-sustaining treatment.


METHODS
Qualitative analysis of prospectively gathered interviews.


METHODS
Six intensive care units at a university medical center.


METHODS
Four hundred six physicians and nurses who were involved in the care of 102 patients for whom withdrawal or withholding of treatment was considered.


METHODS
Semistructured interviews addressed disagreements during life-sustaining treatment decision making. Two raters coded transcripts of the audiotaped interviews.


RESULTS
At least 1 health care provider in 78% of the cases described a situation coded as conflict. Conflict occurred between the staff and family members in 48% of the cases, among staff members in 48%, and among family members in 24%. In 63% of the cases, conflict arose over the decision about life-sustaining treatment itself. In 45% of the cases, conflict occurred over other tasks such as communication and pain control. Social issues caused conflict in 19% of the cases.


CONCLUSIONS
Conflict is more prevalent in the setting of intensive care decision making than has previously been demonstrated. While conflict over the treatment decision itself is most common, conflict over other issues, including social issues, is also significant. By identifying conflict and by recognizing that the treatment decision may not be the only conflict present, or even the main one, clinicians may address conflict more constructively.
Breen
C M
CM
Departments of Pathology, Duke University, Durham, NC.
Abernethy
A P
AP
Abbott
K H
KH
Tulsky
J A
JA
D000368:Aged; D003220:Conflict, Psychological; D003657:Decision Making; D005066:Euthanasia, Passive / Q000523:psychology*; D005195:Family Relations; D005260:Female; D006306:Health Surveys; D006801:Humans; D007400:Interprofessional Relations; D008020:Life Support Care / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011368:Professional-Family Relations; D011787:Quality of Health Care; D016414:Resuscitation Orders / Q000523:psychology*