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American Journal of Critical Care. 2003;12: 548-555
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Life Support Withdrawal: Communication and Conflict

By Sally A. Norton, RN, PhD, Virginia P. Tilden, RN, DNSc, Susan W. Tolle, MD, Christine A. Nelson, RN, MS and Susan Talamantes Eggman, MSW, PhD. From Center for Clinical Research on Aging, University of Rochester School of Nursing, Rochester, NY (SAN), Center for Ethics in Health Care (VPT, SWT), School of Nursing (VPT, CAN), and School of Medicine (SWT), Oregon Health & Science University, Portland, Ore (VPT is now with the College of Nursing, University of Nebraska Medical Center, Omaha, Neb); and Division of Social Work, California State University, Sacramento (STE).

• Background Skillful communication between and among clinicians and patients’ families at the patients’ end of life is essential for decision making. Yet communication can be particularly difficult during stressful situations such as when a family member is critically ill. This is especially the case when families are faced with choices about forgoing life-sustaining treatment.

• Objectives Data from a larger study on treatment withdrawal (n = 74) indicated that the family members (n = 20) of some patients experienced conflict with clinicians during decision making. This secondary analysis was done to examine and describe the communication difficulties from the perspectives of patients’ family members who experienced conflict with clinicians about the care and treatment of the patients during withdrawal of life support.

• Methods A qualitative descriptive analysis of family members (n = 20, representing 12 decedents) who experienced conflict.

• Results Families described several unmet communication needs during the often rapid shift from aggressive treatment to palliative care. These needs included the need for timely information, the need for honesty, the need for clinicians to be clear, the need for clinicians to be informed, and the need for clinicians to listen.

• Conclusions Although family members who experienced conflict were in the minority of the larger study sample, their concerns and needs are important for clinicians to examine. Paying careful attention to these communication needs could reduce the occurrence of conflict between clinicians and patients’ families in caring for dying patients and reduce stress for all involved.




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