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Talking About Suffering in the Intensive Care Unit
Brent M Kious1,2,3, Judith B Vick4, Peter A Ubel5
1Department of Psychiatry, University of Utah, Salt Lake City, Utah, USA.
AJOB Empirical Bioethics
|September 9, 2024
Summary
Clinicians rarely use the term "suffering" to justify limiting end-of-life treatment. While discussed, "suffering" talk was infrequently linked to treatment reduction proposals in critical care family meetings.
Area of Science:
- Medical Ethics
- Clinical Communication
- Palliative Care
Background:
- Hypotheses suggest clinicians may use
- suffering
- discussions to justify limiting end-of-life treatment.
- This study investigates the relationship between discussions of suffering and decision-making for critically ill patients.
Purpose of the Study:
- To examine how clinicians and families discuss
- suffering
- in the context of end-of-life care.
- To determine if discussions of suffering are primarily used to justify limiting treatment.
Main Methods:
- Secondary qualitative content analysis of 146 audio-recorded family meetings in intensive care units.
- Transcripts were analyzed using a consensus-developed coding guide.
- An inductive approach was used with iterative discussion among authors to reach consensus.
Main Results:
- Suffering
- or its variants appeared in 23% of transcripts (34/146).
- Of decision-relevant uses, only 42% (10/24) accompanied a proposal to limit treatment, and half of those (5/10) were clinician-initiated.
- Meanings of suffering included poor prognosis, pain, low quality of life, and emotional distress, often attributed to unconscious patients.
Conclusions:
- Results do not support the claim that
- suffering
- is primarily used by clinicians to justify limiting treatment.
- The terms were not commonly used when decisions were requested, but were often decision-relevant when used.
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