title: Withdrawal of life-sustaining therapy after sudden, unexpected life-threatening illness or injury: interactions between patients' families, healthcare providers, and the healthcare system.
abstract: BACKGROUND
  Withdrawal of life-sustaining therapy in intensive care units is increasing. Patients' families are intimately involved in this process because the patients are usually unable to participate. Little is known about family members' interactions with healthcare providers and the healthcare system during this process.
  
  
  OBJECTIVE
  To describe the interactions between patients' family members, healthcare providers, and the healthcare system during withdrawal of life-sustaining therapy after a sudden, unexpected illness or injury.
  
  
  METHODS
  The investigation was part of a larger interpretative phenomenological study. Nineteen families (56 family members) who participated in the process of withdrawal of life-sustaining therapy for a family member were interviewed and observed. An inductive approach to data analysis was used to discover units of meaning, clusters, and categories.
  
  
  RESULTS
  The families' experiences involved a variety of dimensions, including issues with healthcare providers (bonds and consistency with nurses and physicians, physicians' presence, information, coordination of care, family meetings, sensitivity to time, and preparation for the dying process) and issues with the healthcare system (parking, struggles with finding privacy, and transfers of patients).
  
  
  CONCLUSIONS
  Patients' families need information, guidance, and support as the families participate in the process of withdrawal of life-sustaining therapy. The results of this study have important implications for clinical practice and future research.
authors.affiliation: University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Debra Lynn-McHale
authors.initials: DL
authors.lastname: Wiegand
mesh_terms: D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care; D003695:Delivery of Health Care / Q000592:standards*; D006801:Humans; D007362:Intensive Care Units; D008020:Life Support Care; D010348:Patient Care Team; D010360:Patient Transfer; D018907:Privacy; D011368:Professional-Family Relations; D012944:Social Support; D028761:Withholding Treatment