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Transitioning to End-of-Life Care in the Intensive Care Unit: A Case of Unifying Divergent Desires

Crighton, Margaret H. PhD, RN; Coyne, Bridget M. MSN, CRNP; Tate, Judith MSN, RN; Swigart, Valerie PhD, RN; Happ, Mary Beth PhD, RN

doi: 10.1097/01.NCC.0000339257.14066.d5
Articles

Traditionally, the intensive care unit (ICU) has focused on reversal of life-threatening illness. Patients with incurable cancer admitted to the ICU present unique challenges for clinicians when these patients transition to end-of-life (EOL) care. A dimensional analysis of a single case study from a larger 30-case ethnographic study was used to explore the cancer patient's transition to EOL care in the ICU. Family members and clinicians had different expectations of care, which resulted in divergent treatment goals and desires for the patient, a 62-year-old woman with presumed pneumonia and underlying terminal glioblastoma multiforme. The attending physician and palliative care consultant unified family members' and clinicians' divergent goals and desires through a mediating process of probing the family about the patient's wishes. This process unified those involved and brought them to a place of acceptance. This case illustrates the turning point and rationale for the shift to EOL care in the ICU and the important role that communication plays in the transition. Understanding individual and family processes and family members' need for time to adjust to the transition to EOL is an essential element of practice within ICUs that increasingly manage terminally ill cancer patients.

Authors' Affiliations: School of Nursing (Drs Crighton, Swigart, and Happ, Ms Coyne, and Ms Tate); and Center for Bioethics and Health Law (Dr Happ), University of Pittsburgh, Pennsylvania.

This work was performed at the University of Pittsburgh and supported by the National Institute for Nursing Research, National Institutes of Health, US Public Health Service (grant no. R01 NR07973; principal investigator: M. B. Happ).

Corresponding author: Margaret H. Crighton, PhD, RN, School of Nursing, University of Pittsburgh, 3500 Victoria St, 336 Victoria Building, Pittsburgh, PA 15261 (crighton@pitt.edu).

Accepted for publication June 17, 2008.

© 2008 Lippincott Williams & Wilkins, Inc.