Treatment withdrawal and distress: Recognising the need for better support in critical care-A scoping review

Intensive care units house critically acute patients requiring extensive treatments and specialised care. Highly trained healthcare providers work tirelessly to perform life-sustaining measures, but when all possible treatment options have been exhausted, it sometimes becomes necessary to withdraw treatment. This process places critical care nurses and the interprofessional teams at the centre of emotionally and ethically challenging end-of-life care.

The objective of this review was to synthesise what is known about the types of moral, emotional, and psychological distress experienced by healthcare providers during treatment withdrawal in adult intensive care units and to summarise the support strategies described in the literature to mitigate these experiences.

Nine studies met inclusion criteria, representing 883 healthcare professionals across eight countries. Emotional distress was linked to repeated exposure to death, patient-family relationships, and the act of extubation. Moral distress arose from perceived prolongation of suffering, contradictions with patient wishes, and exclusion from decision-making. None of the studies directly measured psychological distress, representing a critical gap. Nurses consistently reported the greatest burden, often coordinating care and supporting families while being excluded from withdrawal planning. Across all studies, institutionalised support strategies were absent, with providers relying on individual coping mechanisms.

Withdrawing treatment is a task that can lead to emotional and moral distress of healthcare professionals. This review highlights the disconnect between predictable distress and the absence of systematic institutional support. Collaborative planning, standardised withdrawal protocols, mandatory breaks, and structured debriefing could help transform withdrawal experiences into opportunities for meaningful end-of-life care.

The findings suggest that institutionalising interprofessional collaboration, communication training, and postextubation debriefing could reduce moral distress and improve team resilience during terminal extubation procedures.