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Improving the operationalisation of treatment withdrawal in ICUs

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  • Full or part time
    Dr N Efstathiou
    Dr A Hewison
  • Application Deadline
    Applications accepted all year round
  • Self-Funded PhD Students Only
    Self-Funded PhD Students Only

Project Description

Withdrawal of treatment is a common event in Intensive Care Units (ICU) globally when critically ill patients do not respond to treatment and further interventions are considered futile (Mark et al., 2015). Although the timeframe from treatment withdrawal initiation to death tends to be short, when it is poorly handled can cause distress to patients, their relatives and ICU healthcare professionals (Downar et al., 2016). The lack of universally accepted approaches to treatment withdrawal has led to unclear or inconsistent decisions creating confusion and distress (Efstathiou & walker 2014, Efstathiou and Ives 2016, Downar et al., 2016). Attempts to create practice guidelines have been criticised for their quality, safety (Rady & Verheijde, 2016) and their lack of patient or relatives input. In addition, the decision-making processes during the operationalisation of treatment withdrawal has not been explored.

This project aims to explore further the operationalisation of treatment withdrawal and identify patients’, their relatives’ and healthcare professionals’ preferences and decision-making processes in order to improve the experience for all involved. A mixed methods approach would be necessary to achieve the aim of this project. Data could be collected from ICUs that use related practice guidelines and ICUs that have not a standard approach to compare the experiences. Observations, interviews and surveys could be contacted to identify practices that work best for all involved which will contribute to the developing evidence in this area.

Funding Notes

Self Funded Students or those with Sponsorship only


Downar J, Delaney JW, Hawryluck L, Kenny L (2016) Guidelines for the withdrawal of life-sustaining measures. Intensive Care Medicine, 42, 1003-1017

Efstathiou N, Walker W (2014) Intensive care nurses' experiences of providing end-of-life care after treatment withdrawal: A qualitative study. Journal of Clinical Nursing, 23, 3188-3196

Efstathiou N, Ives J (2017) Compassionate care during withdrawal of treatment: A secondary analysis of ICU nurses’ experiences. Nursing Ethics, doi: 10.1177/0969733016687159

Mark NM, Rayner SG, Lee NJ, Curtis JR (2015) Global variability in withholding and withdrawal of life-sustaining treatment in the intensive care unit: A systematic review. Intensive Care Medicine, 41, 1572-1585

Rady MY, Verheijde JL (2016) The Canadian guidelines for the withdrawal of life-sustaining treatment: The role of evidence. Intensive Care Medicine, 42, 1301-1302

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