Improving the operationalisation of treatment withdrawal in ICUs

Background
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.

Project
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.