Decision tools for life support: a review and policy analysis

Area of Science:

• Critical Care Medicine
• Medical Ethics
• Health Policy

Background:

• Life support decisions are complex and require careful consideration.
• Numerous documents exist to guide these critical decisions.
• Understanding the characteristics of these guidance documents is essential for improving their utility.

Purpose of the Study:

• To systematically identify, describe, and compare published documents.
• To analyze guidelines and decision tools for life support administration, withholding, or withdrawal.
• To assess the variability in these tools' development and content.

Main Methods:

• A systematic literature search was conducted for English-language guidelines and decision tools.
• Forty-nine relevant documents were included and coded.
• Data extracted included authorship, source, development methodology, format, and positions on 12 key life-support issues.

Main Results:

• Documents originated from academics, professional organizations, and provider organizations.
• A significant portion (37%) lacked a described development method; many were consensus-based (47%).
• Tools varied in format (schemas, guides, counsels) and addressed diverse issues like advance directives, euthanasia, and brain death, with differing positions.

Conclusions:

• Published life support decision tools exhibit wide variability in their origins, development, format, and focus.
• Discrepancies exist in how these tools address and position themselves on critical life-support dilemmas.
• Future research should investigate the practical application and impact of these tools on clinical practice and patient outcomes.