Physician Family Conflict Following Cardiac Arrest: A Qualitative Study

Area of Science:

• Medical Ethics
• Neurology
• Cardiology

Background:

• Comatose survivors of cardiac arrest face decisions regarding withdrawal of life-sustaining therapy (WLST) due to poor neurologic prognosis.
• Family members serve as surrogate decision-makers, often grappling with the choice to continue mechanical ventilation despite risks.
• Disagreements between physicians and families regarding patient best interests can cause significant distress.

Purpose of the Study:

• To examine the themes influencing families' decisions to pursue continued life support for cardiac arrest survivors against medical recommendations.
• To understand the perspectives and values that guide surrogate decision-making in end-of-life care for critically ill patients.

Main Methods:

• A retrospective review of medical records for 24 cardiac arrest patients at Columbia University Medical Center (CUMC).
• Analysis of documented conversations between patient families and healthcare providers regarding life support decisions.
• Identification and categorization of recurring themes in family-provider discussions.

Main Results:

• Families' decisions for continued life support were influenced by themes such as faith in miracles and a desire for more time with the patient.
• Concerns about "playing God" and differing perceptions of the patient's status between families and providers were prominent.
• Families prioritized values that sometimes diverged from physicians' recommendations based on neurologic prognosis.

Conclusions:

• Family-provider communication and differing value systems significantly impact end-of-life decisions in cardiac arrest survivors.
• Understanding these themes is crucial for improving shared decision-making and reducing distress in critical care settings.
• Further research into bridging these perceptual and value gaps can enhance patient-centered care and family support.