1145 withdraw life support (Table 1). The interviews were interactions with physicians and nurses during end-of-life conducted between May 2008 and November 2009. discussions in the ICU. First, individual interviews were Grounded theory seeks to describe and understand thoroughly analyzed by two researchers (G.F.L. and social and structural processes in social settings. The goal R.L.), with relevant episodes then isolated and arranged of basic grounded theory research is to develop theory into themes [21]. Using the interpretive grounded theory from data collected by the researcher. In this approach, method, the themes were coded and named using various the researcher is more a distant observer. A constructivist terms [20]. The concepts and the relationships between approach recognizes the interaction between the concepts emerged within single interviews and between researcher and the participants and sees both data and interviews, although the emphasis remained on the whole, analyses as created from shared experiences and rela- as in a hermeneutic circle. In organizing the data, initial tionships with participants [20]. codes were chosen to facilitate analysis. The cases were The study was approved by the Regional Committee then labeled based on the participant’s experience of for Medical and Health Research Ethics, the Norwegian inclusion in the decision-making process and then divided Social Science Data Services (NSD), and subsequently by into two groups (Fig. 1). The underlying assumptions of the participating ICUs. the different cases were compared. A common key con- cept emerged: ‘‘wait and see.’’ Sample and data collection Three university hospitals and one district hospital par- ticipated in the study. Hospitals were selected based on their ICU size ([8 beds) and type of unit (general ICU). A sample of family members was selected from each ICU’s patient database by local research coordinators. Inclusion criteria were age greater than 18 years for both the patient and the family member. The decision to withdraw treat- ment was documented in the patient record. Families who had been asked to consent to organ donation were excluded. Information on the study and an invitation to participate were sent from the local research coordinators to the selected family members. Those who elected to participate returned the written consent in a prepaid envelope addressed to one of the researchers (R.L.), who also was the only interviewer. Most interviews took place in the participant’s home. Due to long distances, two interviews were conducted via telephone. Data production and analysis Results Most participants were not included in end-of-life deci- sions (Fig. 1). A few were included to some extent and experienced shared decision-making. The key char- acteristics of the experiences varied, as shown in Fig. 1. The expression ‘‘wait and see’’ was experienced by par- ticipants from both groups, and it was related to communication with both physicians and nurses (see more quotations from participants in Online Resource 2). Five subthemes demonstrate the variety in this main concept: • Unavailability • Ambivalence • Disparate comprehension • Delayed communication • Shared decision-making ‘‘Wait and see’’ The methods of data production and analysis are descri- bed in detail in Online Resource 1. In brief, the interviews Unavailability were held within 3–12 months after the patient’s death, with an average of 9 months (Table 1). An extensive Firstly, the expression ‘‘wait and see’’ may be viewed as a narrative was elicited beginning with a narrative-inducing key concept describing a study participant’s experience of question: ‘‘Can you tell me what happened?’’ The second inadequate communication with ICU clinicians. Few phase of the interview reﬂected the ordering of the themes participants experienced regular physician communica- presented by the interviewee. However, the interviewer tion. The physicians often seemed busy, did not keep also used an interview guide as a background tool to appointments, and left the family waiting for hours. When ensure that relevant topics were covered in the dialog. The family members did succeed in meeting a doctor, they interviews lasted about 1 h, and were digitally recorded found they were rarely given enough time for proper and transcribed verbatim. The data were organized using dialog. One daughter, who was with her father for 1 week NVivo, a software package that facilitates sorting and in the ICU, states: ‘‘There was little… very little com- coding. munication. The only time we talked with doctors was The goal of the analysis was to gain an understanding that time the two doctors sat down with us. We had no of the family members’ roles and reactions during contact apart from what we heard from the discussion