Interventions for shared decision-making about life support in the intensive care unit: a systematic review

Healthcare professionals and families make decisions about the use of life support for patients in the intensive care unit (ICU), including decisions to withhold or withdraw life support at the end-of-life. Best practice guidelines recommend using a shared decision-making (SDM) approach to improve the quality of end-of-life decision-making but do not describe how this should be done in practice.

To know what elements of SDM had been tested to improve communication between healthcare professionals, patients, and their family about the decision. Trials relevant to our review assessed whether these interventions were more effective than usual care.

A systematic review of randomized controlled trials of SDM interventions for the decision about using life support, limiting the use of life support, or withdrawing life support for hospitalized patients. We searched databases from inception to January 2011.

Of 3,162 publications, four unique trials were conducted between 1992 and 2005. Of four trials, three interventions were evaluated. Two studies of interventions including three of nine elements of SDM did not report improvements in communication. Two studies of the same ethics consultation, which included eight of nine elements of SDM, did not evaluate the benefit to communication. The interventions were not harmful; they decreased family member anxiety and distress, shortened intensive care unit stay, but did not affect patient mortality.

Few studies have evaluated interventions to improve communication between healthcare professionals and patients/families when facing the decision about whether or not to use life support in the ICU. Interventions that include essential elements of SDM need to be more thoroughly evaluated in order to determine their effectiveness and health impact and to guide clinical practice.