Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jul 11;17(1):93.
doi: 10.1186/s12871-017-0384-5.

End-of-life perceptions among physicians in intensive care units managed by anesthesiologists in Germany: a survey about structure, current implementation and deficits

Manfred Weiss  1 , Andrej Michalsen  2 , Anke Toenjes  3 , Franz Porzsolt  4 , Thomas Bein  5 , Marc Theisen  6 , Alexander Brinkmann  7 , Heinrich Groesdonk  8 , Christian Putensen  9 , Friedhelm Bach  10 , Dietrich Henzler  11 ; On behalf on the Working Group Epidemiology and Ethics of the German Society of Anesthesiology and Intensive Care Medicine (DGAI)
Affiliations

End-of-life perceptions among physicians in intensive care units managed by anesthesiologists in Germany: a survey about structure, current implementation and deficits

Manfred Weiss et al. BMC Anesthesiol. .

Abstract

Background: Structural aspects and current practice about end-of-life (EOL) decisions in German intensive care units (ICUs) managed by anesthesiologists are unknown. A survey among intensive care anesthesiologists has been conducted to explore current practice, barriers and opinions on EOL decisions in ICU.

Methods: In November 2015, all members of the German Society of Anesthesiology and Intensive Care Medicine (DGAI) and the Association of German Anesthesiologists (BDA) were asked to participate in an online survey to rate the presence or absence and the importance of 50 items. Answers were grouped into three categories considering implementation and relevance: Category 1 reflects high implementation and high relevance, Category 2 low and low, and Category 3 low and high.

Results: Five-hundred and forty-one anesthesiologists responded. Only four items reached ≥90% agreement as being performed "yes, always" or "mostly", and 29 items were rated "very" or "more important". A profound discrepancy between current practice and attributed importance was revealed. Twenty-eight items attributed to Category 1, six to Category 2 and sixteen to Category 3. Items characterizing the most urgent need for improvement (Category 3) referred to patient outcome data, preparation of health care directives and interdisciplinary discussion, standard operating procedures, implementation of practical instructions and inclusion of nursing staff and families in the process.

Conclusion: The present survey affirms an urgent need for improvement in EOL practice in German ICUs focusing on advanced care planning, distinct aspects of changing goals of care, implementation of standard operating procedures, continuing education and reporting of outcome data.

Keywords: Anesthesiologists; Education, Continuing; End-of-life care; Goals; Intensive care units; Palliative care; Patient care planning; Prognosis; Quality of life; Surveys and questionnaires.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

For the present survey, a formal ethcis approval was not required: in Germany, the provincial medical associations regularly waive the need for ethics approval regarding voluntary surveys without use of personal data and with adequate anonymisation (see § 15 section 1 code of medical ethics of the Medical Association of Mecklenburg-Vorpommern ( http://www.aek-mv.de/upload/file/presse/Berufsordnung%205_%20%2B%206_%20Änderung.pdf ; https://ethik.med.uni-rostock.de/antragsstellung/forschungsvorhaben/ ) as well as of the Central Ethical Committee of the Medical Association of North Rhine ( https://www.aekno.de/page.asp?pageID=124 ; https://www.aekno.de/page.asp?pageID=5257 ). Thus, the DGAI also supported the survey without need for formal ethics approval.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
EOL items Q8–11 of high implementation and high relevance (sufficient Category 1). Data are presented as “blob-o-grams” were the number of respondents in each category is represented by a circle whose area is proportional to the number. Importance (x-axis) and status of implementation (y-axis) are rated on modified Likert scales. Q = Question. C1 = sufficient Category 1
Fig. 2
Fig. 2
EOL items Q44–46 of low implementation and low relevance (inessential Category 2). Data are presented as “blob-o-grams” were the number of respondents in each category is represented by a circle whose area is proportional to the number. Importance (x-axis) and status of implementation (y-axis) are rated on modified Likert scales. Q = Question. C2 = inessential Category 2
Fig. 3
Fig. 3
EOL items Q4 – Q7 of high importance that are rarely implemented but are considered to be highly relevant (unsatisfactory Category 3). Data are presented as “blob-o-grams” were the number of respondents in each category is represented by a circle whose area is proportional to the number. Importance (x-axis) and status of implementation (y-axis) are rated on modified Likert scales. Q = Question. C3 = unsatisfactory Category 3
See this image and copyright information in PMC

References

    1. Myburgh J, Abillama F, Chiumello D, Dobb G, Jacobe S, Kleinpell R, Koh Y, Martin C, Michalsen A, Pelosi P, et al. End-of-life care in the intensive care unit: Report from the Task Force of World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care. 2016;34:125–130. doi: 10.1016/j.jcrc.2016.04.017. - DOI - PubMed
    1. Graw JA, Spies CD, Wernecke KD, Braun JP. Managing end-of-life decision making in intensive care medicine--a perspective from Charite Hospital, Germany. PLoS One. 2012;7(10) doi: 10.1371/journal.pone.0046446. - DOI - PMC - PubMed
    1. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580–637. doi: 10.1097/CCM.0b013e31827e83af. - DOI - PubMed
    1. Le-Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270(24):2957–2963. doi: 10.1001/jama.1993.03510240069035. - DOI - PubMed
    1. Vincent JL, de Mendonca A, Cantraine F, Moreno R, Takala J, Suter PM, Sprung CL, Colardyn F, Blecher S. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26(11):1793–1800. doi: 10.1097/00003246-199811000-00016. - DOI - PubMed