SHM Converge Scientific Abstract ePoster Gallery-A Novel Framework of Approaches to Limiting Life-Prolonging Intervention

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This multi-institutional qualitative study examined how clinicians limit life-sustaining interventions near the end of life. Across 113 interviews with physicians, advanced practice providers, nurses, and social workers at three West Coast academic medical centers, the authors used deductive and inductive coding to build a framework of clinician approaches.<br /><br />The study found five approaches, arranged from least to most directive based on how strongly clinicians guide patients or surrogates toward limiting treatment. These approaches are:  <br />1. Present interventions in terms of physiologic indications.  <br />2. Provide options linked to patient outcomes.  <br />3. Make a recommendation to limit interventions.  <br />4. Do not offer interventions.  <br />5. Invoke an institutional process to limit interventions as a last resort.<br /><br />A key finding was that the more confident clinicians were that an intervention would not benefit the patient, the more strongly they tended to steer decisions toward limiting treatment. When direct communication failed, clinicians described turning to institutional processes to resolve conflict. Opinions varied widely on the ethical acceptability and usefulness of each approach, and some approaches did not align neatly with existing bioethical guidelines.<br /><br />The study offers a practical framework and shared language for understanding how clinicians de-escalate care in high-intensity end-of-life settings. It also highlights the limits of standard shared decision-making models when clinicians believe treatment is non-beneficial.

Asset Subtitle

Elizabeth W. Dzeng

Meta Tag

Author List Ariadne Nichol, Elizabeth W. Dzeng, Helen Chernicoff, Jacob Blythe, Jacqueline Kruser, Jason Batten, Lorraine Pereira, Sofia Weiss-Goitiandia

Category Research

Concept End-of-Life Care

Concept Life-Sustaining Intervention

Concept Treatment Limitation

Concept Therapy Ineffectiveness

Concept Shared Decision-Making

Distinguished Non-Finalist

Presenter Organization Ucsf

Presenting Author Elizabeth W. Dzeng

Track Communication

Keywords

end-of-life care

life-sustaining interventions

clinician decision-making

shared decision-making

treatment limitation

non-beneficial treatment

institutional process

qualitative study

physician communication

care de-escalation

End-of-Life Care

Life-Sustaining Intervention

Treatment Limitation

Therapy Ineffectiveness

Shared Decision-Making