The impact of religion on changes in end-of-life practices in European intensive care units: a comparative analysis over 16 years.
Active shortening of the dying process
End of life
Intensive care units
Religion
Withdrawing life-sustaining treatments
Withholding life-sustaining treatments
Journal
Intensive care medicine
ISSN: 1432-1238
Titre abrégé: Intensive Care Med
Pays: United States
ID NLM: 7704851
Informations de publication
Date de publication:
11 2023
11 2023
Historique:
received:
22
05
2023
accepted:
08
09
2023
medline:
3
11
2023
pubmed:
9
10
2023
entrez:
9
10
2023
Statut:
ppublish
Résumé
Religious beliefs affect end-of-life practices in intensive care units (ICUs). Changes over time in end-of-life practices were not investigated regarding religions. Twenty-two European ICUs (3 regions: Northern, Central, and Southern Europe) participated in both Ethicus-1 (years 1999-2000) and Ethicus-2 studies (years 2015-2016). Data of ICU patients who died or had limitations of life-sustaining therapy were analysed regarding changes in end-of-life practices and patient/physician religious affiliations. Frequencies, timing of decision-making, and religious affiliations of physicians/patients were compared using the same definitions. In total, 4592 adult ICU patients (n = 2807 Ethicus-1, n = 1785 Ethicus-2) were analysed. In both studies, patient and physician religious affiliations were mostly Catholic, Greek Orthodox, Jewish, Protestant, or unknown. Treating physicians (but not patients) commonly reported no religious affiliation (18%). Distribution of end-of-life practices with respect to religion and geographical regions were comparable between the two studies. Withholding [n = 1143 (40.7%) Ethicus-1 and n = 892 (50%) Ethicus-2] and withdrawing [n = 695 (24.8%) Ethicus-1 and n = 692 (38.8%) Ethicus-2] were most commonly decided. No significant changes in end-of-life practices were observed for any religion over 16 years. The number of end-of-life discussions with patients/ families/ physicians increased, while mortality and time until first decision decreased. Changes in end-of-life practices observed over 16 years appear unrelated to religious affiliations of ICU patients or their treating physicians, but the effects of religiosity and/or culture could not be assessed. Shorter time until decision in the ICU and increased numbers of patient and family discussions may indicate increased awareness of the importance of end-of-life decision-making in the ICU.
Identifiants
pubmed: 37812228
doi: 10.1007/s00134-023-07228-z
pii: 10.1007/s00134-023-07228-z
pmc: PMC10622347
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1339-1348Investigateurs
C Sprung
(C)
R Bernstein
(R)
A Avidan
(A)
Charles L Sprung
(CL)
Matthew Anstey
(M)
Alexander Avidan
(A)
Elie Azoulay
(E)
Julie Benbenishty
(J)
Du Bin
(D)
Deborah Cook
(D)
Randy Curtis
(R)
Charles Feldman
(C)
Christiane Hartog
(C)
Gavin Joynt
(G)
Motoshi Kainuma
(M)
Mitchell Levy
(M)
R K Mani
(RK)
Andrej Michalsen
(A)
Bara Ricou
(B)
Marcio Soares
(M)
Robert Truog
(R)
D Ledoux
(D)
C Ingels
(C)
D Nalos
(D)
J Gjedsted
(J)
C Hartog
(C)
S Zakynthinos
(S)
C Mathas
(C)
G Nakos
(G)
B Koulouras
(B)
G Papathanakos
(G)
O Miskolci
(O)
C L Sprung
(CL)
A Avidan
(A)
V de la Guardia
(V)
A Farran
(A)
V Van Heerden
(V)
M Klein
(M)
P Levin
(P)
A Palo
(A)
A Girbes
(A)
P Maia
(P)
L Bento
(L)
J M G Garcia
(JMG)
A Vidal Tegedor
(AV)
B Ricou
(B)
S Marsch
(S)
J C Schefold
(JC)
F Esen
(F)
D Brealey
(D)
Informations de copyright
© 2023. The Author(s).
Références
Sprung CL et al (2021) The influence of geography, religion, religiosity and institutional factors on worldwide end-of-life care for the critically ill: the WELPICUS study. J Palliat Care. https://doi.org/10.1177/08258597211002308
doi: 10.1177/08258597211002308
pubmed: 33818159
Sprung CL et al (2019) Changes in end-of-life practices in European intensive care units from 1999 to 2016. JAMA 322(17):1692–1704. https://doi.org/10.1001/jama.2019.14608
doi: 10.1001/jama.2019.14608
pubmed: 31577037
pmcid: 6777263
Avidan A et al (2021) Variations in end-of-life practices in intensive care units worldwide (Ethicus-2): a prospective observational study. Lancet Respir Med 9(10):1101–1110. https://doi.org/10.1016/S2213-2600(21)00261-7
doi: 10.1016/S2213-2600(21)00261-7
pubmed: 34364537
Bülow HH et al (2012) Are religion and religiosity important to end-of-life decisions and patient autonomy in the ICU? The Ethicatt study. Intensive Care Med 38(7):1126–1133. https://doi.org/10.1007/s00134-012-2554-8
doi: 10.1007/s00134-012-2554-8
pubmed: 22527070
Lautrette A et al (2007) A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med 356(5):469–478. https://doi.org/10.1056/NEJMoa063446
doi: 10.1056/NEJMoa063446
pubmed: 17267907
Sprung CL et al (2007) The importance of religious affiliation and culture on end-of-life decisions in European intensive care units. Intensive Care Med 33(10):1732–1739. https://doi.org/10.1007/s00134-007-0693-0
doi: 10.1007/s00134-007-0693-0
pubmed: 17541550
Blank RH (2011) End-of-life decision making across cultures. J Law Med Ethics 39(2):201–214. https://doi.org/10.1111/j.1748-720X.2011.00589.x
doi: 10.1111/j.1748-720X.2011.00589.x
pubmed: 21561515
Phua J et al (2015) Withholding and withdrawal of life-sustaining treatments in intensive care units in Asia. JAMA Intern Med 175(3):363–371. https://doi.org/10.1001/jamainternmed.2014.7386
doi: 10.1001/jamainternmed.2014.7386
pubmed: 25581712
Meñaca A et al (2012) End-of-life care across Southern Europe: a critical review of cultural similarities and differences between Italy, Spain and Portugal. Crit Rev Oncol Hematol 82(3):387–401. https://doi.org/10.1016/j.critrevonc.2011.06.002
doi: 10.1016/j.critrevonc.2011.06.002
pubmed: 21741855
Sprung CL et al (2003) End-of-life practices in European intensive care units the Ethicus study. JAMA 290(6):790–797. https://doi.org/10.1001/jama.290.6.790
doi: 10.1001/jama.290.6.790
pubmed: 12915432
Bates D, Mächler M, Bolker B, Walker S (2015) Fitting linear mixed-effects models using lme4. J Stat Softw 67:1–48. https://doi.org/10.18637/jss.v067.i01
doi: 10.18637/jss.v067.i01
Kuznetsova A, Brockhoff PB, Christensen RHB (2017) lmerTest package: tests in linear mixed effects models. J Stat Softw 82:1–26. https://doi.org/10.18637/jss.v082.i13
doi: 10.18637/jss.v082.i13
Højsgaard S, Halekoh U, Yan J (2006) The R package geepack for generalized estimating equations. J Stat Softw 15:1–11. https://doi.org/10.18637/jss.v015.i02
doi: 10.18637/jss.v015.i02
Dayimu A (2022) ‘Forestploter: Create Flexible Forest Plot’. [Online]. https://CRAN.R-project.org/package=forestploter . Accessed 4 Nov 2022
Schweda M, Schicktanz S, Raz A, Silvers A (2017) Beyond cultural stereotyping: views on end-of-life decision making among religious and secular persons in the USA, Germany, and Israel. BMC Med Ethics 18(1):13. https://doi.org/10.1186/s12910-017-0170-4
doi: 10.1186/s12910-017-0170-4
pubmed: 28212642
pmcid: 5316158
El Jawiche R, Hallit S, Tarabey L, Abou-Mrad F (2020) Withholding and withdrawal of life-sustaining treatments in intensive care units in Lebanon: a cross-sectional survey of intensivists and interviews of professional societies, legal and religious leaders. BMC Med Ethics 21(1):80. https://doi.org/10.1186/s12910-020-00525-y
doi: 10.1186/s12910-020-00525-y
pubmed: 32859185
pmcid: 7456082
Kilbride MK, Joffe S (2018) The new age of patient autonomy: implications for the patient-physician relationship. JAMA 320(19):1973–1974. https://doi.org/10.1001/jama.2018.14382
doi: 10.1001/jama.2018.14382
pubmed: 30326026
pmcid: 6988779
Bülow HH et al (2008) The world’s major religions’ points of view on end-of-life decisions in the intensive care unit. Intensive Care Med 34(3):423–430. https://doi.org/10.1007/s00134-007-0973-8
doi: 10.1007/s00134-007-0973-8
pubmed: 18157484