Limiting life-sustaining treatment in German intensive care units: a multiprofessional survey.
OBJECTIVE
Deciding about the limitation of life-sustaining treatment (LST) is a major challenge for intensive care medicine. The aim of the study was to investigate the practices and perspectives of German intensive care nurses and physicians on limiting LST.


METHODS
We conducted an anonymous, self-administered questionnaire survey among the 268 nurses and 95 physicians on all 10 intensive care units of the Munich University Hospital, Germany.


RESULTS
The response rate was 53%. Of all respondents, 91% reported being confronted with the topic at least once a month. Although all reported limiting cardiopulmonary resuscitation, almost no one reported limiting artificial hydration. Half of nurses and junior physicians felt uncertain about the decision-making process. Junior physicians were most dissatisfied with their training for this task and expressed the highest fear of litigation. Nurses were less satisfied than physicians with the communication process. Both nurses and relatives were not routinely involved in decision making. There is no standardized documentation practice, and many notes are not readily accessible to nurses.


CONCLUSIONS
Limiting LST is common in German intensive care units. The major shortcomings are team communication, communication with the patient's family, and documentation of the decision-making process.
Jox
Ralf J
RJ
Interdisciplinary Center for Palliative Medicine, Munich University Hospital, Marchioninistrasse 15, D-81377 Munich, Germany. ralf.jox@med.lmu.de
Krebs
Mirjam
M
Fegg
Martin
M
Reiter-Theil
Stella
S
Frey
Lorenz
L
Eisenmenger
Wolfgang
W
Borasio
Gian Domenico
GD
D001291:Attitude of Health Personnel; D016887:Cardiopulmonary Resuscitation / Q000523:psychology; D003657:Decision Making; D004282:Documentation; D005260:Female; D005440:Fluid Therapy / Q000523:psychology; D005858:Germany; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D007400:Interprofessional Relations; D008020:Life Support Care / Q000523:psychology*; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology*; D009741:Nursing Staff, Hospital / Q000523:psychology*; D015279:Organizational Culture; D057184:Practice Patterns, Nurses'; D010818:Practice Patterns, Physicians'; D011368:Professional-Family Relations; D012930:Social Dominance; D011795:Surveys and Questionnaires; D028761:Withholding Treatment