Purpose: Palliative care consultants play an increasing role in assisting critical care clinicians
with end-of-life communication in the intensive care unit (ICU). One of the ethical principles
these consultants may apply to such communication is nonabandonment of the patient. Limited
data exist concerning expressions of nonabandonment in the ICU family conference. This
analysis examines expressions of nonabandonment during ICU family conferences. Our goal
was to categorize these expressions and develop a conceptual model for understanding this
issue as it arises in the ICU setting.
Methods: We identified family conferences in the ICUs of four hospitals. Conferences were
eligible if the attending physician believed that discussion about withholding or withdrawing
life support or the delivery of bad news was likely to occur. Fifty-one conferences were
audiotaped, transcribed, and analyzed using grounded theory.
Results: We identified categories capturing expressions of nonabandonment in the ICU family
conference. Clinicians expressed nonabandonment of the patient or family in three ways:
alleviating suffering/ensuring comfort, allowing family members to be present at the bedside
for the death, and being accessible to patients and families. Families expressed their own nonabandonment
of the patient or concern about abandonment of the patient by the health care
team in five ways: ensuring the patient's suffering is eased, being present at the bedside, ensuring
the patient's end-of-life preferences are respected, ensuring that everything possible
be done to cure the patient, and "letting go." These categories were placed into a conceptual
model that differentiates explicit and implicit statements of nonabandonment.
Conclusions: This paper describes categories and a conceptual model for understanding expressions
of nonabandonment that may allow palliative care consultants to help critical care
clinicians express nonabandonment and respond to families' expressions of nonabandonment
in the ICU family conference. Future studies could use this model to develop a communication
intervention for the ICU family conference.
