gms | German Medical Science

Objective: To identify a possible post-decision conflict in relatives, who were involved in end-of-life decisions for terminal ill patients on a neurosurgical intensive care unit (ICU).

Method: Between May 2012 and January 2014 all cases of deaths on our ICU were analysed with respect to an involvement of the relatives of the patients in end-of-life decisions. A total of 36 cases was identified, in whom relatives were involved. The relatives were contacted for a standardized telephone interview. 15 relatives gave their consent in the study and could be included into the final analysis. 21 items were operationalized for the interview and analysed with a principal component matrix (SPSS Vers. 19.0).

Results: From the rotating principal component matrix a seven-factorial solution could be extracted with a constant substantial impact for each item on the according factor. From this, a post-decision conflict could be ruled out in all cases, possibly influenced by individual reduction mechanisms of a cognitive dissonance. Time for the decision making was generally estimated to be too short in the pending situation. Yet, only two interviewed relatives indicated that they were still fraught with recurrent memories of the situation.

Conclusions: The involvement of relatives in end-of-life decisions on our ICU did not lead to post-decision conflicts. Still, the majority of relatives would have appreciated to have more time for the decision. This may indicate that employing the relatives in a decision-making process at an early stage can possibly relieve this late distress in the relatives. From our data, we may encourage physicians and neurosurgeons to approach the relatives of critical ill patients at an early stage when a fatal outcome may be foreseen.