The role of advance directives and family in end-of-life decisions in critical care units.
OBJECTIVE
To define the extent and nature of the End-of-Life (EOL) decision-making process in critically ill patients.


METHODS
Retrospective review of all deaths in adult medical and surgical intensive care units of a tertiary care hospital over a one-year period.


RESULTS
There were sixty-one deaths in the study period. The mean age was 68 years, and 30 patients (49%) were female. Nearly one-third of patients had advance directives: eight patients presented advance directives on hospital admission, and 10 families produced advance directives at EOL. Seventy-six percent were admitted to the ICU as Code I (full care) and 24% were Code II (selective modification of care). At EOL, 10 patients were Code I, 14 were Code II, and 38 were transitioned to Code III (comfort care only). In the Code III population, the change in code status was initiated by the family in 12 cases.


CONCLUSIONS
In a substantial number of instances transitioned to comfort care at EOL, the family initiated the code-status change. Interestingly, in several cases the family initially withheld advance directives. Critically ill patients and their families are assuming an active role in EOL care.
Kavic
Stephen M
SM
Department of Surgery, Bridgeport Hospital, Yale-New Haven Health System, Bridgeport, CT, USA. skavic@yahoo.com
Atweh
Nabil
N
Possenti
Paul P
PP
Ivy
Michael E
ME
D000368:Aged; D003422:Critical Care; D003657:Decision Making; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D010347:Patient Care Planning; D012189:Retrospective Studies; D013727:Terminal Care