緩和ケアと医学

抽象的な

What is Important to Families in Intensive Care Once a Decision has been Made to Withdraw Treatment

Maureen A Coombs

Objective: How doctors and nurses talk with families about decisions that lead to treatment withdrawal in intensive care is important and has been well explored. However less is known about what family members perceive as important once this decision has been made. This study explores the needs of family members during and after treatment has been withdrawn in intensive care. Methods: An interpretive qualitative design was undertaken. Purposive sampling identified 112 deceased patients of whom 62 met the study criteria. From this sample, 17 in-depth interviews were conducted with 21 family members who had been bereaved in the previous 6-12 months. Thematic analysis was performed on the transcribed interviews. Results: Whilst family members were able to broadly recollected conversations with doctors and nurses about the decision to withdraw treatment, there were detailed accounts of what was important to family members after that decision was made. In this, family members recalled wanting to: alleviate further suffering, re-establish identity of, and re-connect relationships with, the dying person.Bereaved family members spoke about the activities they undertook to realize these. At interview, family members demonstrated on-going distress about situations perceived as preventing achievement of these. Conclusions: Families have existential and relational needs during and after treatment withdrawal in intensive care. Doctors and nurses must recognize the importance of assessing these family goals, identifying information that enables families to choose how such needs can be met, and developing skills to manage situations when these needs cannot be met.