Withdrawal/Withholding Life-Sustaining Therapies: Factors that Influence Family Decisions

Recent national surveys demonstrate a gap between individual stated preference in the face of future life-threatening illness and the typical experience for Americans who are terminally or critically ill. In actuality, in the last six months of life, a person on Medicare has a 15-50% likelihood of spending time in critical care. It is predicted that 11% will spend seven days or greater in a critical care, and at least 30% will spend their last days of life in critical care on life-sustaining treatments (The Dartmouth Atlas of Health Care, 1999). Often many of these individuals are unable to make decisions for themselves, leaving family with the decision to withhold or withdraw life-sustaining therapies. The purpose of this descriptive, qualitative study involving exploratory, semistructured interviews of five individuals was to discern the factors that influence family decisions to withdraw or withhold life-sustaining treatments for an incapacitated ill family member. The five participants provided information about six decisions to withdraw or withhold treatment. One decision was to withhold treatment and the remaining decisions were to withdraw life-sustaining therapy. Content analysis revealed the following themes: (a) clarity of wishes of the ill family member, (b) certainty of prognosis, and (c) perception of suffering. Families poignantly described the impact each these themes had on the decision to withdraw or withhold life-sustaining therapy. Participants described the experience as it related to the communication from family and health care providers involved in the decision-making process. They illustrated both supportive and burdensome communication experienced during the decision-making process. Ineffective communication delayed the decisionmaking process as families sought certainty about the ill loved ones\u27 medical condition and prognosis. Participants described relationships that imparted trust and helped bring resolution to issues that arose during the deliberation of the decision to withdraw or withhold life-sustaining treatments. The findings provided insight for nursing practice and other health care professionals when working with families who are involved in these decisions. The results have raised additional questions about how we can further study this important aspect of care. In addition, nursing education recommendations were presented