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Cited by 103Palliative Care and End-of-Life IssuesFamily and Patient Care in Intensive Care UnitsEthics in medical practice

Communication tools for end-of-life decision-making in the intensive care unit: a systematic review and meta-analysis

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Oczkowski, Simon J. W., Chung, Han-Oh, Hanvey, Louise, Mbuagbaw, Lawrence, You, John J.·2016·Critical Care
DOI 10.1186/s13054-016-1264-yPMC PMC4826553
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Abstract

BACKGROUND: For many patients admitted to the intensive care unit (ICU), preferences for end-of-life care are unknown, and clinicians and substitute decision-makers are required to make decisions about the goals of care on their behalf. We conducted a systematic review to determine the effect of structured communication tools for end-of-life decision-making, compared to usual care, upon the number of documented goals of care discussions, documented code status, and decisions to withdraw life-sustaining treatments, in adult patients admitted to the ICU. METHODS: We searched multiple databases including MEDLINE, Embase, CINAHL, ERIC, and Cochrane from database inception until July 2014. Two reviewers independently screened articles, assessed eligibility, verified data extraction, and assessed risk of bias using the tool described by the Cochrane Collaboration and the Newcastle Ottawa Scale. Pooled estimates of effect (relative risk, standardized mean difference, or mean difference), were calculated where sufficient data existed. GRADE was used to evaluate the overall quality of evidence for each outcome. RESULTS: We screened 5785 abstracts and reviewed the full text of 424 articles, finding 168 eligible articles, including 19 studies in the ICU setting. The use of communication tools increased documentation of goals-of-care discussions (RR 3.47, 95% CI 1.55, 7.75, p = 0.020, very low-quality evidence), but did not have an effect on code status documentation (RR 1.03, 95% CI 0.96, 1.10, p = 0.540, low-quality evidence) or decisions to withdraw or withhold life-sustaining treatments (RR 0.98, 95% CI 0.89, 1.08, p = 0.70, low-quality evidence). The use of such tools was associated with a decrease in multiple measures of health care resource utilization, including duration of mechanical ventilation (MD -1.9 days, 95% CI -3.26, -0.54, p = 0.006, very low-quality evidence), length of ICU stay (MD -1.11 days, 95% CI -2.18, -0.03, p = 0.04, very low-quality evidence), and health care costs (SMD -0.32, 95% CI -0.5, -0.15, p < 0.001, very low-quality evidence). CONCLUSIONS: Structured communication tools may improve documentation of EOL decision making and may result in lower resource use. The supporting evidence is low to very low in quality. Further high-quality randomized studies of simple communication interventions are needed to determine whether structured, rather than ad hoc, approaches to end-of-life decision-making improve patient-level, family-level, and system-level outcomes. TRIAL REGISTRATION: PROSPERO CRD42014012913.

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  • A recent, multicenter RCT of advanced cancer patients reported that consultation plus early palliative care did not affect family satisfaction with care.

    “However, a recent, multicenter RCT of advanced cancer patients reported that consultation plus early palliative care did not affect family satisfaction with care. 53”

    From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [53]

    The Results (Secondary outcomes; page not provided) report no significant difference in family satisfaction in an RCT. But the Study characteristics describe that trial as a palliative-care-related intervention in medical and surgical ICUs involving patients who died there or shortly after transfer—not a trial of consultation plus early palliative care for advanced cancer patients. (LLM, conf=0.88)

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Cited by

Sorted by citations

Authors
Oczkowski, S. J. W., Chung, H.-O., Hanvey, L., Mbuagbaw, L., & You, J. J.
Affiliations
  • McMaster University (CA)
  • Canadian Hospice Palliative Care Association (CA)
  • St. Joseph’s Healthcare Hamilton (CA)
Corresponding author
Oczkowski, Simon J. W.
ORCID
Venue
Critical Care
Publisher
Springer Science and Business Media LLC
Published
2016-04-09
Volume
20
Issue
1
Pages
97-97
ISSN
1364-8535 (ISSN-L)
DOI
10.1186/s13054-016-1264-y
PMC
PMC4826553
OpenAlex
W2312758743
Cited by
103
References
7
Citations by year
2026: 8 · 2025: 6 · 2024: 14 · 2023: 4 · 2022: 14 · 2021: 12 · 2020: 8 · 2019: 14 · 2018: 9 · 2017: 11 · 2016: 2 · 2015: 1
FWCI
1.79
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Critical Care (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
Technology Evaluation in the Elderly Network (KS 2014-06)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Health Professions › Radiological and Ultrasound Technology › Family and Patient Care in Intensive Care Units
  • Health Sciences › Health Professions › General Health Professions › Ethics in medical practice
Keywords
end-of-life decisions, intensive care unit, communication tools, goals of care discussions, code status, withdrawal of life-sustaining treatment, withholding life-sustaining treatment, mechanical ventilation duration, ICU length of stay, health care costs, healthcare resource utilization, advance care planning, surrogate decision-making, quality of life, quality of life at death
MeSH terms
Communication, Decision Support Techniques, Humans, Intensive Care Units, Patient Education as Topic, Patient Participation, Respiration, Artificial

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