DECIDING WHETHER TO WITHHOLD OR WITHDRAW LIFE-SUSTAINING TREATMENT (LIFE SUPPORT, DYING).
Contributors: University of Kansas.
Published: 1994
Number of pages: 368
Subjects: Health Sciences, Nursing.
Description: This two component study was designed to identify and understand factors influencing whether life-sustaining treatment was withheld or withdrawn from the technology dependent patient unlikely to survive. A social context survey (SCS) provided institutional norms, and a multiple case design (MCD) explored attitudes and situational factors influencing health care professionals and family members of 10 representative intensive care unit patients in the real-life setting.

Institutional norms were established for attitudes about death (death anxiety, death confrontation, death integration), quality of life (satisfaction and values), and withholding and withdrawing life-sustaining treatment. Psychometric evaluation of the investigator-developed withholding and withdrawing scales yielded three factors for each scale with loadings greater than.50. Cronbach's alpha for these subscales ranged from.81 to.95.

For the 10 cases in the MCD, participant observation, semi-structured interviews, and the SCS attitude measures were used for data collection. Family members and health care professionals were assigned to role categories (advocate, resister, or neutral participant) according to their behavior related to withholding or withdrawing. Individual attitude scores within each role category were compared with the SCS medians. Scoring trends related to advocate and resister roles were evident on measures of death confrontation and integration and attitudes toward withdrawing life-sustaining treatment. Results were inconclusive for death anxiety, quality of life, and withholding life-sustaining treatment.

Within-case and cross-case analyses revealed that situational factors (patients' wishes and nearly hopeless prognoses) were driving forces for the seven withdrawing and three withholding decisions. Two patients survived to return home. In four cases decisions were harmonious, in three moderate dissension occurred, and in three there was serious dissension, with distrust between family members and health care professionals a discriminating factor. Most surprising, cost of treatment was a major issue in only one case and in that case only for the health care professionals involved.

Further study of situations with serious dissension is recommended to better understand the issues underlying distrust. A larger multisite study is recommended to better understand relationships between personal attitudes and roles related to withholding and withdrawing life-sustaining treatment.
Notes: Source: Dissertation Abstracts International, Volume: 55-10, Section: B, page: 4323.

Thesis (PH.D.)--UNIVERSITY OF KANSAS, 1994.

School code: 0099.