title: Communication of end-of-life decisions in European intensive care units.
abstract: OBJECTIVE
  To examine end-of-life (EOL) practices in European ICUs: who makes these decisions, how they are made, communication of these decisions and questions on communication between the physicians, nurses, patients and families.
  
  
  METHODS
  Data collected prospectively on EOL decisions facilitated by a questionnaire including EOL decision categories, geographical regions, mental competency, information about patient wishes, and discussions with patients, families and health care professionals.
  
  
  METHODS
  37 European ICUs in 17 countries.
  
  
  METHODS
  ICU physicians collected data on 4,248 patients.
  
  
  RESULTS
  95% of patients lacked decision making capacity at the time of EOL decision and patient's wishes were known in only 20% of cases. EOL decisions were discussed with the family in 68% of cases. Physicians reported having more information about patients' wishes and discussions in the northern countries (31%, 88%) than central (16%, 70%) or southern (13%, 48%) countries. The family was more often told (88%) than asked (38%) about EOL decisions. Physicians' reasons for not discussing EOL care with the family included the fact that the patient was unresponsive to therapy (39%), the family was unavailable (28%), and the family was thought not to understand (25%).
  
  
  CONCLUSIONS
  ICU patients typically lack decision-making capacity, and physicians know patients' wishes in only 20% of EOL decisions. There were regional differences in discussions of EOL decisions with families and other physicians. In European ICUs there seems to be a need to improve communication.
authors.affiliation: Department of Medicine, University College London, London, UK. simon.cohen@ucl.ac.uk
authors.forename: Simon
authors.initials: S
authors.lastname: Cohen
authors.forename: Charles
authors.initials: C
authors.lastname: Sprung
authors.forename: Peter
authors.initials: P
authors.lastname: Sjokvist
authors.forename: Anne
authors.initials: A
authors.lastname: Lippert
authors.forename: Bara
authors.initials: B
authors.lastname: Ricou
authors.forename: Mario
authors.initials: M
authors.lastname: Baras
authors.forename: Seppo
authors.initials: S
authors.lastname: Hovilehto
authors.forename: Paulo
authors.initials: P
authors.lastname: Maia
authors.forename: Dermot
authors.initials: D
authors.lastname: Phelan
authors.forename: Konrad
authors.initials: K
authors.lastname: Reinhart
authors.forename: Karl
authors.initials: K
authors.lastname: Werdan
authors.forename: Hans-Henrik
authors.initials: HH
authors.lastname: Bulow
authors.forename: Tom
authors.initials: T
authors.lastname: Woodcock
mesh_terms: D003142:Communication; D003657:Decision Making; D005060:Europe; D005190:Family / Q000523:psychology*; D006801:Humans; D007362:Intensive Care Units; D008505:Medical Staff, Hospital / Q000523:psychology*; D016743:Mental Competency; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology*