Plain English Summary
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
Trial website
Contact information
Type
Scientific
Primary contact
Dr Alma Nordenskjöld Syrous
ORCID ID
https://orcid.org/0000-0002-8599-204X
Contact details
c/o Block
Blå stråket 5
Sahlgrenska universitetssjukhuset
Gothenburg
41345
Sweden
+46 (0)735344214
alma.syrous@vgregion.se
Additional identifiers
EudraCT number
Nil known
ClinicalTrials.gov number
Nil known
Protocol/serial number
Nil known
Study information
Scientific title
Reasons for provider-caused variability in end-of-life decision-making in intensive care
Acronym
Study hypothesis
To investigate contributing factors behind provider-caused variability in end of life decision making (ELDM) in intensive care units.
Ethics approval
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
Study design
Qualitative sub-study of a previously conducted interview study
Primary study design
Observational
Secondary study design
Trial setting
Hospitals
Trial type
Other
Patient information sheet
Not available in web format, please use the contact details below to request a participant information sheet
Condition
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
Phase
Drug names
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 trial start date
01/04/2017
Overall trial end date
30/05/2017
Reason abandoned (if study stopped)
Eligibility
Participant inclusion criteria
Consultants working in the ICU of the participating centre
Participant type
Health professional
Age group
Mixed
Gender
Both
Target number of participants
19
Total final enrolment
19
Participant exclusion criteria
Does not meet the inclusion criteria
Recruitment start date
01/04/2017
Recruitment end date
30/05/2017
Locations
Countries of recruitment
Sweden
Trial participating centre
Hallands sjukhus Vargberg
Varberg
43237
Sweden
Trial participating centre
Helsingborgs lasarett
Helsingborg
25223
Sweden
Trial participating centre
NÄL
Trollhättan
46173
Sweden
Trial participating centre
Universitets sjukhuset i Linköping
Linköping
58185
Sweden
Trial participating centre
Norrlands universitets sjukhus Umeå
Umeå
90737
Sweden
Sponsor information
Organisation
University of Gothenburg
Sponsor details
Box 100
Gothenburg
40530
Sweden
+46 (0)31 786 10 00
registrator@gu.se
Sponsor type
University/education
Website
Funders
Funder type
Government
Funder name
Healthcare Board, Region Västra Götaland
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Funder name
Swedish government and the county councils
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Funder name
The Gothenburg Society of Medicine
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Results and Publications
Publication and dissemination plan
The researchers would like to publish in Critical Care.
IPD sharing statement:
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
Intention to publish date
01/09/2020
Participant level data
Available on request
Basic results (scientific)
Publication list