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
Observational Study
. 2022 Apr:68:83-88.
doi: 10.1016/j.jcrc.2021.12.006. Epub 2021 Dec 21.

Changes in communication of end-of-life decisions in European ICUs from 1999 to 2016 (Ethicus-2) - a prospective observational study

Christiane S Hartog  1 , Paulo A Maia  2 , Bara Ricou  3 , Chris Danbury  4 , Laura Galarza  5 , Joerg C Schefold  6 , Eldar Soreide  7 , Maria G Bocci  8 , Anne Pohrt  9 , Charles L Sprung  10 , Alexander Avidan  10
Affiliations
Observational Study

Changes in communication of end-of-life decisions in European ICUs from 1999 to 2016 (Ethicus-2) - a prospective observational study

Christiane S Hartog et al. J Crit Care. 2022 Apr.

Abstract

Purpose: We investigated changes in communication practice about end-of-life decisions in European ICUs over 16 years.

Materials and methods: This prospectively planned secondary analysis of two observational studies in 22 European ICUs in 1999-2000 (Ethicus-1) and 2015-16 (Ethicus-2) included consecutive patients who died or with limitation of life-sustaining therapy. ICUs were grouped into North, Central and South European regions.

Results: A total 4592 patients were included in 1999-2000 (n = 2807) and 2015-16 (n = 1785). Information about patient wishes increased overall (from 25.4% [570] to 51.1% [840]) and in all regions (42% to 61% [North], 22% to 56% [Central] and 20% to 32% [South], all p < 0.001). Discussions of treatment limitations with patients or families increased overall (66.0% to 76.1%) and in Northern and Central Europe (87% to 94% and 75% to 82.2%, respectively, all p < 0.001) but not in the South. Strongest predictor for discussions was the region (North>Central>South) followed by patient decision-making capacity.

Conclusion: End-of-life decisions are increasingly discussed but communication practices vary by region and follow a North-South gradient. Despite increased availability of information, patient preferences still remain unknown in every second patient. This calls for increased efforts to assess patient preference in advance and make them known to ICU clinicians.

Keywords: Communication; Death; Intensive Care Units; Withholding treatment.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest CSH reports funding grants paid to her institution from the Innovation Funds of the German Federal Joint Committee (FKZ 01VSF19020, FKZ 01VSF17010) and the European Society of Intensive Care Medicine (ESICM) (2018–2021). JCS (full departmental disclosure) reports grants from Orion Pharma, Abbott Nutrition International, B. Braun Medical AG, CSEM AG, Edwards Lifesciences Services GmbH, Kenta Biotech Ltd., Maquet Critical Care AB, Omnicare Clinical Research AG, Nestle, Pierre Fabre Pharma AG, Pfizer, Bard Medica S.A., Abbott AG, Anandic Medical Systems, Pan Gas AG Healthcare, Bracco, Hamilton Medical AG, Fresenius Kabi, Getinge Group Maquet AG, Dräger AG, Teleflex Medical GmbH, Glaxo Smith Kline, Merck Sharp and Dohme AG, Eli Lilly and Company, Baxter, Astellas, Astra Zeneca, CSL Behring, Novartis, Covidien, Nycomed, and Phagenesis, outside of the submitted work. The money went into departmental funds, no personal financial gain applied. All other authors declare no potential conflict of interest.

Publication types

LinkOut - more resources