End-of-Life Decision Support in the ICU: Where Are We Now?
Grant Pignatiello, Ronald L Hickman, Breanna Hetland
PMID 28322634WHAT IT FOUND
End-of-life decision support in the ICU has not shown a clearly effective way to help surrogate decision makers.
Some interventions improved family comprehension or reduced distress, but results were inconsistent.
Key findings
01The review included 22 publications; six studies were randomized, 16 were quasi-experimental, and no study blinded personnel or outcome evaluators.
02Decision support interventions sometimes improved surrogate understanding: pamphlets increased comprehension of diagnosis, prognosis, and treatment regimen, and CPR videos increased surrogate CPR knowledge.
03Effects on key outcomes were inconsistent: mortality studies failed to show a consistent influence, and satisfaction studies were mostly nonsignificant or mixed.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
Six included studies were randomized, 16 were quasi-experimental, and no study blinded staff or outcome evaluators. Only 30% of studies evaluated mortality, and emotional or cognitive outcomes were evaluated by only two studies. The search was conducted in December 2015, so newer studies may be missing. Studies varied in design, participants, interventions, and outcomes, and this made comparison difficult. No included study used a theoretical framework, so it is unclear which intervention components mattered. The authors may have missed relevant studies despite reference checking.
The easy way to misread this
Do not conclude that ICU end-of-life decision aids improve patient or family outcomes. The review included weak, heterogeneous studies with no blinding and inconsistent effects, and it found no clearly effective way to support families.