title: Seeking worldwide professional consensus on the principles of end-of-life care for the critically ill. The Consensus for Worldwide End-of-Life Practice for Patients in Intensive Care Units (WELPICUS) study.
abstract: Great differences in end-of-life practices in treating the critically ill around the world warrant agreement regarding the major ethical principles. This analysis determines the extent of worldwide consensus for end-of-life practices, delineates where there is and is not consensus, and analyzes reasons for lack of consensus. Critical care societies worldwide were invited to participate. Country coordinators were identified and draft statements were developed for major end-of-life issues and translated into six languages. Multidisciplinary responses using a web-based survey assessed agreement or disagreement with definitions and statements linked to anonymous demographic information. Consensus was prospectively defined as >80% agreement. Definitions and statements not obtaining consensus were revised based on comments of respondents, and then translated and redistributed. Of the initial 1,283 responses from 32 countries, consensus was found for 66 (81%) of the 81 definitions and statements; 26 (32%) had >90% agreement. With 83 additional responses to the original questionnaire (1,366 total) and 604 responses to the revised statements, consensus could be obtained for another 11 of the 15 statements. Consensus was obtained for informed consent, withholding and withdrawing life-sustaining treatment, legal requirements, intensive care unit therapies, cardiopulmonary resuscitation, shared decision making, medical and nursing consensus, brain death, and palliative care. Consensus was obtained for 77 of 81 (95%) statements. Worldwide consensus could be developed for the majority of definitions and statements about end-of-life practices. Statements achieving consensus provide standards of practice for end-of-life care; statements without consensus identify important areas for future research.
authors.affiliation: 1 Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Sprung
authors.forename: Robert D
authors.initials: RD
authors.lastname: Truog
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
authors.forename: Gavin M
authors.initials: GM
authors.lastname: Joynt
authors.forename: Mario
authors.initials: M
authors.lastname: Baras
authors.forename: Andrej
authors.initials: A
authors.lastname: Michalsen
authors.forename: Josef
authors.initials: J
authors.lastname: Briegel
authors.forename: Jozef
authors.initials: J
authors.lastname: Kesecioglu
authors.forename: Linda
authors.initials: L
authors.lastname: Efferen
authors.forename: Edoardo
authors.initials: E
authors.lastname: De Robertis
authors.forename: Pierre
authors.initials: P
authors.lastname: Bulpa
authors.forename: Philipp
authors.initials: P
authors.lastname: Metnitz
authors.forename: Namrata
authors.initials: N
authors.lastname: Patil
authors.forename: Laura
authors.initials: L
authors.lastname: Hawryluck
authors.forename: Constantine
authors.initials: C
authors.lastname: Manthous
authors.forename: Rui
authors.initials: R
authors.lastname: Moreno
authors.forename: Sara
authors.initials: S
authors.lastname: Leonard
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Hill
authors.forename: Elisabet
authors.initials: E
authors.lastname: Wennberg
authors.forename: Robert C
authors.initials: RC
authors.lastname: McDermid
authors.forename: Adam
authors.initials: A
authors.lastname: Mikstacki
authors.forename: Richard A
authors.initials: RA
authors.lastname: Mularski
authors.forename: Christiane S
authors.initials: CS
authors.lastname: Hartog
authors.forename: Alexander
authors.initials: A
authors.lastname: Avidan
mesh_terms: D001926:Brain Death; D003422:Critical Care / Q000941:ethics / Q000379:methods / Q000592:standards*; D016638:Critical Illness; D003657:Decision Making; D006801:Humans; D007258:Informed Consent / Q000941:ethics / Q000592:standards; D007362:Intensive Care Units / Q000941:ethics / Q000592:standards; D007391:International Cooperation; D010166:Palliative Care / Q000941:ethics / Q000379:methods / Q000592:standards; D013727:Terminal Care / Q000941:ethics / Q000379:methods / Q000592:standards*; D028761:Withholding Treatment / Q000941:ethics / Q000592:standards
keywords: cardiopulmonary resuscitation; do-not-resuscitate orders; end-of-life decisions; intensive care unit; withholding and withdrawing life-sustaining treatment