How do Swedish critical care physicians make decisions in end-of-life care?
| ISRCTN | ISRCTN14496722 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN14496722 |
- Submission date
- 07/07/2020
- Registration date
- 13/08/2020
- Last edited
- 13/08/2020
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Other
Plain English summary of protocol
There is increasing evidence that the main factor for variability in end of life decision making (ELDM) in intensive care units is caused by the individual provider. Although end of life decisions are often complex and should be adapted to every single patient and situation, provider-caused variability is problematic as it may cause unequal care that affects patient outcomes. The primary aim of this study was to investigate contributing factors behind provider-caused variability in ELDM.
This is a qualitative sub-study of a previously conducted interview study. In-depth thematic analyses of semi-structured interviews with 19 critical care specialists from 5 different Swedish intensive care units (ICU's) were performed. Interviews took place between February 1st 2017 to May 31st, 2017.
Timing and decisiveness in ELDM vary with the physician's personality as well as professional and personal experiences. Many of the respondents were aware they might be affected by prejudices and values in ELDM. Respondents did not think that their own religious beliefs played any part in ELDM.
Respondents expressed they dreaded to be regarded as careless or ill-advised, and conflicts and criticism were described as emotionally draining and were therefore avoided. Junior consultants were more inclined to acknowledge that lack of personal and organisational resources influences ELDM, whereas senior consultants stressed that these factors did not affect the ELDM.
Background and study aims
To make end-of-life (EOL) decisions is a complex and challenging task for intensive care physicians and a substantial variability in this process has been previously reported. However, a deeper understanding of intensivists’ experiences and attitudes regarding the decision-making process is still, to a large extent, lacking. The primary aim of this study was to address Swedish intensivists’ experiences, beliefs and attitudes regarding decision-making pertaining to EOL decisions and to identify underlying factors that may contribute to variability in the decision-making process.
Who can participate?
Swedish consultants who actively practice in critical-care units
What does the study involve?
Face to face interviews with critical-care consultants in 5 different hospitals in Sweden
What are the possible benefits and risks of participating?
For a specific person participating in our study there should be very little risk to harm. benefits are to express ones understanding of making these difficult and complex decisions.
Where is the study run from?
The Sahlgrenska University Hospital, Gothenburg, (Sweden)
When is the study starting and how long is it expected to run for?
From February 2017 to May 2017
Who is funding the study?
This study was financed by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF agreement (ALFGBG-772521, ALFGBG-722301) and the Healthcare Board, Region Västra Götaland, (VGFOUREG-833561). The Gothenburg Society of Medicine (GLS-884181) Swedish Medical Society (SLS-930544).
Who is the main contact?
alma.syrous@vgregion.se
Contact information
Scientific
c/o Block, Blå stråket 5, Sahlgrenska universitetssjukhuset
Gothenburg
41345
Sweden
 ORCID ID |
0000-0002-8599-204X |
|---|---|
| Phone | +46 (0)735344214 |
| alma.syrous@vgregion.se |
Study information
| Study design | Qualitative sub-study of a previously conducted interview study |
|---|---|
| Primary study design | Observational |
| Secondary study design | |
| Study setting(s) | Hospital |
| Study type | Other |
| Participant information sheet | Not available in web format, please use the contact details below to request a participant information sheet |
| Scientific title | Reasons for provider-caused variability in end-of-life decision-making in intensive care |
| Study objectives | To investigate contributing factors behind provider-caused variability in end of life decision making (ELDM) in intensive care units. |
| Ethics approval(s) | Approved 04/03/2013, the Authority for ethical approvement Etikprövningsmyndigheten (Box 2110, 750 02 Uppsala, Sweden; +46 (0)10-475 08 00; registrator@etikprovning.se), ref: Dnr 616‐16 |
| Health condition(s) or problem(s) studied | End of life decisions in ICU |
| Intervention | In-depth thematic analyses of semi-structured interviews with 19 critical care specialists from five different Swedish intensive care units (ICUs) are performed. Interviews take place between February 1st 2017 and May 31st 2017. Data collected included freely expressed reflections on beliefs and experiences of each consultant about decision-making in end-of-life care. No follow-up was planned or performed. |
| Intervention type | Other |
| Primary outcome measure | Factors that gives variation to Swedish intensivists’ experience in decisions in end-of-life care freely expressed reflections on beliefs and experiences of consultants about decision-making in end-of-life care in face to face semi-structured interviews in 2017 |
| Secondary outcome measures | There are no secondary outcome measures |
| Overall study start date | 01/04/2017 |
| Completion date | 30/05/2017 |
Eligibility
| Participant type(s) | Health professional |
|---|---|
| Age group | Mixed |
| Sex | Both |
| Target number of participants | 19 |
| Total final enrolment | 19 |
| Key inclusion criteria | Consultants working in the ICU of the participating centre |
| Key exclusion criteria | Does not meet the inclusion criteria |
| Date of first enrolment | 01/04/2017 |
| Date of final enrolment | 30/05/2017 |
Locations
Countries of recruitment
- Sweden
Study participating centres
43237
Sweden
25223
Sweden
46173
Sweden
58185
Sweden
90737
Sweden
Sponsor information
University/education
Box 100
Gothenburg
40530
Sweden
| Phone | +46 (0)31 786 10 00 |
|---|---|
| registrator@gu.se | |
| Website | http://www.gu.se/english |
"ROR" |
https://ror.org/01tm6cn81 |
Funders
Funder type
Government
No information available
No information available
No information available
Results and Publications
| Intention to publish date | 01/09/2020 |
|---|---|
| Individual participant data (IPD) Intention to share | Yes |
| IPD sharing plan summary | Available on request |
| Publication and dissemination plan | The researchers would like to publish in Critical Care. |
| IPD sharing plan | All data was anonymized. All respondents in the qualitative studies get verbal and written information and signed consent. Data is kept at Sahlgrenska University hospital and are available on request to linda.block@vgregion.se |
Editorial Notes
13/08/2020: Trial’s existence confirmed by Regionala Etikprövningsnämnden i Göteborg.
