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Seeking Worldwide Professional Consensus on the Principles of End-of-Life Care for the Critically Ill. The Consensus for Worldwide End-of-Life Practice for Patients in Intensive Care Units (WELPICUS) Study
Abstract
Great differences in end-of-life practices in treating the critically ill around the world warrant agreement regarding the major ethical principles. This analysis determines the extent of worldwide consensus for end-of-life practices, delineates where there is and is not consensus, and analyzes reasons for lack of consensus. Critical care societies worldwide were invited to participate. Country coordinators were identified and draft statements were developed for major end-of-life issues and translated into six languages. Multidisciplinary responses using a web-based survey assessed agreement or disagreement with definitions and statements linked to anonymous demographic information. Consensus was prospectively defined as >80% agreement. Definitions and statements not obtaining consensus were revised based on comments of respondents, and then translated and redistributed. Of the initial 1,283 responses from 32 countries, consensus was found for 66 (81%) of the 81 definitions and statements; 26 (32%) had >90% agreement. With 83 additional responses to the original questionnaire (1,366 total) and 604 responses to the revised statements, consensus could be obtained for another 11 of the 15 statements. Consensus was obtained for informed consent, withholding and withdrawing life-sustaining treatment, legal requirements, intensive care unit therapies, cardiopulmonary resuscitation, shared decision making, medical and nursing consensus, brain death, and palliative care. Consensus wa…
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“Structured, complex, multifaceted interventions in the context of advance care planning and shared decision making may effectively prevent disproportionate/unwanted end-of-life care and accordingly reduce use of healthcare resources. 4,7,44,72,355,398”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [7]
In the citing paper
“Data from eight RCTs included in three systematic reviews indicated that communication interventions aiding the completion of advance directives had no significant effect on patient/family satisfaction with end-of-life care. 4,7,8”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [7]
In the citing paper
“Evidence from 13 RCTs and from 8 nonrandomised studies included in 3 systematic reviews suggests associations of communication interventions with an increased frequency of DNACPR orders. 4,7,8,10”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [7]
In the citing paper
“Despite the limitations of the currently available, substantial but still heterogenous, body of evidence, the presence of either positive or neutral RCTs on structured communication tools aimed at facilitating the completion of advance care directives and plans suggests a class effect and increased likelihood of benefit compared with usual care. 4,7”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [7]
In the citing paper
“Accordingly, the certainty of existing evidence has been judged most frequently as low to very low by authors of systematic reviews. 7 10,28,38,39,43,44,72”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [7]
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Metadata
- Authors
- Sprung, C. L., Truog, R. D., Curtis, J. R., Joynt, G. M., Baras, M., Michalsen, A., Briegel, J., Kesecioglu, J., Efferen, L., De Robertis, E., Bulpa, P., Metnitz, P., Patil, N., Hawryluck, L., Manthous, C., Moreno, R., Leonard, S., Hill, N. S., Wennberg, E., McDermid, R. C., Mikstacki, A., Mularski, R. A., Hartog, C. S., & Avidan, A.
- Affiliations
- Hadassah Medical Center (IL)
- Boston Children's Hospital (US)
- University of Washington (US)
- Chinese University of Hong Kong (HK)
- Hebrew University of Jerusalem (IL)
- Department of Anaesthesiology and Critical Care Medicine, Tettnang Hospital, Tettnang, Germany
- Ludwig-Maximilians-Universität München (DE)
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- South Nassau Communities Hospital (US)
- Department of Neurosciences, Reproductive and Odontostomatologic Sciences, University of Naples, Federico II, Naples, Italy
- UCLouvain (BE)
- University of Vienna (AT)
- Brigham and Women's Hospital (US)
- Toronto Western Hospital (CA)
- Medical Intensive Care Unit, Lawrence and Memorial Hospital, New London, Connecticut
- Unidade Local de Saúde de São José (PT)
- King's College Hospital (GB)
- Tufts Medical Center (US)
- University of Gothenburg (SE)
- University of Alberta (CA)
- Department of Anaesthesiology and Intensive Therapy, Regional Hospital, Poznań, Poland
- Kaiser Permanente (US)
- Jena University Hospital (DE)
- Corresponding author
- Sprung, Charles L.
- ORCID
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-10-01
- Volume
- 190
- Issue
- 8
- Pages
- 855-866
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- OpenAlex
- W2110407084
- Cited by
- 250
- References
- 43
- Citations by year
- 2026: 13 · 2025: 10 · 2024: 19 · 2023: 16 · 2022: 30 · 2021: 26 · 2020: 40 · 2019: 19 · 2018: 16 · 2017: 19 · 2016: 16 · 2015: 22 · 2014: 4
- FWCI
- 20.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Digital Access to Libraries (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- end-of-life care, critically ill patients, intensive care unit, international consensus, ethical principles, withholding and withdrawing life-sustaining treatment, informed consent, cardiopulmonary resuscitation, shared decision-making, brain death, palliative care
- MeSH terms
- Brain Death, Critical Care, Decision Making, Humans, Informed Consent, Intensive Care Units, International Cooperation, Palliative Care, Terminal Care, Critical Illness, Withholding Treatment
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