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What-End-of-Life-Communication-in-ICUs-Around-the-
What-End-of-Life-Communication-in-ICUs-Around-the-
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The article discusses the practices surrounding end-of-life communication in intensive care units (ICUs) worldwide, focusing on the concept of shared decision-making, which involves collaboration among clinicians, patients, and families to make informed decisions about treatment goals based on individual values. The study, conducted by Feldman and colleagues as part of the Ethicus-2 study, examines data from 199 ICUs across 36 countries, highlighting significant regional variability in practices.<br /><br />Key findings indicate that discussions regarding the limitations of life-sustaining therapies occur in 84.9% of cases overall but with regional differences. For instance, these discussions are frequent in some areas like North America but less so in Southern Europe and Latin America. The study reveals that patient participation in decision-making is limited, with family members or surrogates often acting on behalf of patients. Most discussions are initiated by ICU physicians, though initiation by family members is more common in Asia. In North America, initiation is more evenly distributed among various parties.<br /><br />The study introduces the "ethical practice score," based on 12 variables representative of ethical end-of-life care practices, which correlates with increased likelihood of end-of-life discussions. The presence of an advance directive significantly raises the odds of such discussions occurring.<br /><br />The research provides a benchmark for future studies and suggests that certain factors could enhance end-of-life communication by eliciting patient and family values. The study emphasizes that while shared decision-making is rare globally, the differences observed should be approached with cultural sensitivity to adapt communication practices to different cultural contexts. Through its findings, the study encourages improved shared decision-making and culturally sensitive communication to enhance the quality of end-of-life care worldwide.
Keywords
end-of-life communication
intensive care units
shared decision-making
patient participation
ethical practice score
advance directive
cultural sensitivity
regional variability
life-sustaining therapies
Ethicus-2 study
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