title: Withholding or withdrawing therapy in intensive care units: an analysis of collaboration among healthcare professionals.
abstract: OBJECTIVE
  The purpose of the study was to determine the views of intensive care nurses, intensivists, and primary physicians regarding collaboration and other aspects of withholding and withdrawing therapy in the intensive care unit (ICU).
  
  
  METHODS
  A questionnaire survey was conducted in seven hospitals in the Region of Southern Denmark, including six regional and four university ICUs. Four hundred ninety-five nurses, 135 intensivists, and 146 primary physicians participated in the study. The primary physicians came from two regional hospitals.
  
  
  RESULTS
  The unified response rate was 84%. "Futile therapy" and "Patient's wish" were for all participants the main reasons for considering withholding or withdrawing therapy. Of primary physicians 63% found their general experience of collaboration very or extremely satisfactory compared to 36% of intensivists and 27% of nurses. Forty-three percent of nurses, 29% of intensivists, and 2% of primary physicians found that decisions regarding withdrawal of therapy were often, very often, or always unnecessarily postponed. Intensivists with ICU as their main workplace were more satisfied with the collaboration and more rarely found that end-of-life decisions were changed or postponed compared to intensivists who did not have ICU as their main workplace.
  
  
  CONCLUSIONS
  Nurses, intensivists and primary physicians differ in their perception of collaboration and other aspects of withholding and withdrawing therapy practises at the ICU. Multi-disciplinary patient conferences, nurse involvement in the decision-making process, and guidelines for withholding and withdrawing therapy are recommended.
authors.affiliation: Department of Anaesthesiology, Vejle Hospital, (V66), Kabbeltoft 25, 7100 Vejle, Denmark. hanne.irene.jensen@slb.regionsyddanmark.dk
authors.forename: Hanne Irene
authors.initials: HI
authors.lastname: Jensen
authors.forename: Jette
authors.initials: J
authors.lastname: Ammentorp
authors.forename: Mogens
authors.initials: M
authors.lastname: Erlandsen
authors.forename: Helle
authors.initials: H
authors.lastname: Ording
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D003422:Critical Care; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D009729:Nursing; D011320:Primary Health Care; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D028761:Withholding Treatment