title: Nurse involvement in end-of-life decision making: the ETHICUS Study.
abstract: OBJECTIVE
  The purpose was to investigate physicians' perceptions of the role of European intensive care nurses in end-of-life decision making.
  
  
  METHODS
  This study was part of a larger study sponsored by the Ethics Section of the European Society of Intensive Care Medicine, the ETHICUS Study. Physicians described whether they thought nurses were involved in such decisions, whether nurses initiated such a discussion and whether there was agreement between physicians and nurses. The items were analyzed and comparisons were made between different regions within Europe.
  
  
  METHODS
  The study took place in 37 intensive care units in 17 European countries.
  
  
  METHODS
  Physician investigators reported data related to patients from 37 centers in 17 European countries.
  
  
  METHODS
  None.
  
  
  RESULTS
  Physicians perceived nurses as involved in 2,412 (78.3%) of the 3,086 end-of-life decisions (EOLD) made. Nurses were thought to initiate the discussion in 66 cases (2.1%), while ICU physicians were cited in 2,438 cases (79.3%), the primary physician in 328 cases (10.7%), the consulting physician in 105 cases (3.4%), the family in 119 cases (3.9%) and the patient in 19 cases (0.6%). In only 20 responses (0.6%) did physicians report disagreement between physicians and nurses related to EOLD. A significant association was found between the region and responses to the items related to nursing. Physicians in more northern regions reported more nurse involvement.
  
  
  CONCLUSIONS
  Physicians perceive nurses as involved to a large extent in EOLDs, but not as initiating the discussion. Once a decision is made, there is a sense of agreement. The level of perceived participation is different for different regions.
authors.affiliation: Hadassah Medical Organization, Jerusalem, Israel.
authors.forename: Julie
authors.initials: J
authors.lastname: Benbenishty
authors.forename: Freda DeKeyser
authors.initials: FD
authors.lastname: Ganz
authors.forename: Anne
authors.initials: A
authors.lastname: Lippert
authors.forename: Hans-Henrik
authors.initials: HH
authors.lastname: Bulow
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Wennberg
authors.forename: Beverly
authors.initials: B
authors.lastname: Henderson
authors.forename: Mia
authors.initials: M
authors.lastname: Svantesson
authors.forename: Mario
authors.initials: M
authors.lastname: Baras
authors.forename: Dermot
authors.initials: D
authors.lastname: Phelan
authors.forename: Paulo
authors.initials: P
authors.lastname: Maia
authors.forename: Charles L
authors.initials: CL
authors.lastname: Sprung
mesh_terms: D000328:Adult; D003431:Cross-Cultural Comparison; D003657:Decision Making; D005060:Europe; D006801:Humans; D024802:Nurse's Role; D009729:Nursing; D019555:Physician-Nurse Relations; D011365:Professional Practice Location; D013727:Terminal Care; D028761:Withholding Treatment