End of Life Care

Withholding and withdrawing life-sustaining therapy. ATS Statement. Am Rev Respir Dis 1991;144:726-31. Statement covers patient autonomy, surrogate decision-making, and futility. http://www.thoracic.org/sections/publications/statements/pages/other-interests/wwlst.html

Tonelli MR. Pulling the plug on living wills. Chest 1996;110:816-22. Discusses the difficulties and limitations of formulating and applying advanced directives. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8797430

A controlled trial to improve care for seriously ill hospitalized patients. SUPPORT Investigators. JAMA 1995;274:1591-8. This landmark study found interventions to increase physician awareness of prognosis and facilitate communication between physicians and patients or surrogates made no significant difference compared to controls. Preference for CPR was discussed with a minority of patients; physicians often were unaware of their patients' preferences for CPR. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7474243

Luce JM. Making decisions about the forgoing of life-sustaining therapy. Amer J Respir Crit Care 1997;156:1715-8. Commentary that summarizes much of the recent research in this area. Emphasizes the need to reaffirm patient autonomy and to be cautious in the use of "futility" as a reason to withdraw care. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9412545

Truog RD, Cist AFM, Brackett SE, et al. Recommendations for end-of-life care in the intensive care unit: The Ethics Committee of the Society of Critical Care Medicine.  Crit Care Med 2001;29:2332-48.  Recommendations for clinical care of dying patients in the ICU derived from research and expert opinion. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11801837

Azoulay E, Pochard F, Kentish-Barnes N, et al. Risk of post-traumatic stress symptoms in family members of intensive care unit patients.  Am J Respir Crit Care Med  2005; 171:987-94.  This French study is noteworthy for evaluating risk factors for stress-related symptoms in a large cohort of family members of ICU patients.  Interviews of 284 primary decision makers 90 days after the patients’ ICU discharge or death found that 33% were deemed to be at moderate to high risk of PTSD.  Risk of PTSD was associated with perception of incomplete information in the ICU, shared decision-making, ICU death of the relative, ICU death of the relative after end-of-life decisions, and sharing in end-of-life decisions. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=15665319&query_hl=40&itool=pubmed_DocSum

Lautrette A, Darmon M, Megarbane B, et al. A communication strategy and brochure for relatives of patients dying in the ICU.  N Engl J Med  2007; 356:469-78.  This French study of family members of 126 patients that died in an ICU found the use of a brochure on bereavement combined with a proactive communication strategy lowered symptoms of anxiety, depression, and PTSD. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17267907&query_hl=42&itool=pubmed_docsum