1147 for recovery. Being near the patient most of the time knew the patient’s preferences. Generally, the physicians makes the family form their own ideas about the patient’s focused entirely on the clinical details when they announced prognosis. Even if family members recognize some signs their decision to withdraw treatment. Several family mem- indicating that the patient’s situation is worsening, they bers, while presuming that the correct decision had been need to maintain some hope for survival. Many found that made, would still have preferred greater involvement in the doctors and nurses took this into account by shielding decision-making process. Looking back, one son said: ‘‘Her them. The vague communication with nurses was inter- quality of life was not part of the discussion… no, in fact it preted as part of this. They reﬂected upon the concept that was not… They should have discussed it with me… that is this is a difﬁcult balancing act for hospital staff. Some- what I think. It is actually a moral question. It is really times they received clear, realistic information that the difﬁcult’’ (no. 18). Several family members recall the situ- situation could go either way. In retrospect, many felt that ation as emotionally charged. Some were left with uncertainty was hidden behind a focus on continued full unanswered questions, leading to doubt about whether the treatment and the hope for improvement. A wife said that correct decision was made. They were unsure whether they ‘‘they never actually said it would not work out, to start had received all necessary information or if there were other with. They had hope, and we clung to it’’ (no. 9). aspects to be considered. Moreover, since termination of care was usually carried out very quickly, they had no time to reﬂect upon it or express doubts. Disparate comprehension Thirdly, ‘‘wait and see’’ can indicate differing viewpoints Shared decision-making and perceptions of the clinicians and the family. Several study participants were unsure about what would happen For a few family members the ‘‘wait and see’’ period after ‘‘waiting and seeing.’’ One participant states: ‘‘When worked as a preparation phase for the decision-making he talked to me then, he prepared me for the meeting at process (Fig. 1). These families experienced early family the weekend when they would decide what would happen. meetings in which clinicians made efforts to establish a And there would be a heart specialist and other experts at relationship and provide the family with emotional support. the meeting’’ (no. 16). In retrospect, the families realized In later meetings, the patient’s preferences were discussed that ‘‘wait and see’’ was in fact used to convey treatment and treatment goals were revised. Nurses sometimes took termination at a given time, unless there were unexpected part in the family meetings. An elderly man who lost his signs of improvement. Others had previously understood wife said: ‘‘In a way, I was prepared by the process which it as meaning that the doctors were uncertain about the went on continuously, and the talks with those two fantastic outcome. However, several family members felt that the professionals. And it was obvious to me that it was her life it end-of-life discussion after the ‘‘wait and see’’ period was was all about, and on the doctor’s recommendation I saw no over came up too abruptly. reason to continue the treatment’’ (no. 12). Other partici- pants also found that the physicians acted as their advisers, inviting them to take part in the ﬁnal decision. Delayed communication Fourthly, the ‘‘wait and see’’ period sometimes delayed the important part of the discussion regarding the deci- Discussion sion-making process and made it difﬁcult for the family to recognize their role as surrogates for the patient. Some The major ﬁnding of this study is that the concept of family members were relieved to discover that the phy- ‘‘wait and see’’ describes the communication process with sicians are responsible for decisions, but still had a families in the participating Norwegian ICUs in various perception of the importance of their own contribution. ways. Despite well-documented strategies to prepare One woman, married for more than 30 years, said: ‘‘My families for end-of-life decisions [22–24], the families’ husband and I were very conscious of wanting to be the perspectives in this study reveal an ineffective and closest relatives and part of this was to be conﬁdent that ambiguous communication strategy. This is an area where the spouse made the best decision’’ (no. 1). Despite the the data can be interpreted in different ways. The end-of- fact that few patients had previously discussed end-of-life life decision may seem sudden and unexpected because goals within their family, the relatives believed they knew the family is not mentally prepared. We also know that the end-of-life wishes of the patient. They based this on being in an emotionally charged situation may reduce the their previous generalized conversations on moral values family’s ability to recognize the physicians’ information and end-of-life goals. This carries with it a strong feeling [22]. However, it can also be considered as an unclear of responsibility to communicate this knowledge to the communication process where the reality of the situation clinicians. However, few participants were asked if they is played down.