Thoughts of ER doctors and nurses when family members of patients with a terminal illness act as surrogate decision makers

Abstract

Objective: To elucidate the thoughts of doctors and nurses on surrogate decision-making by families of terminally ill patients in the emergency room.

Methods: Semi-structured interviews were conducted with seven emergency medicine specialists and eight certified emergency nurses. The results were analyzed qualitatively and inductively using Krippendorff’s content analysis.

Results: The analysis generated 209 codes, 19 subcategories, and 5 categories for physicians, and 334 codes, 27 subcategories, and 5 categories for nurses.

Conclusions: Doctors thought that prioritizing patients’ wishes required encouraging both patients and families to engage in advance care planning. Families, on the other hand, were reluctant to place the burden of surrogate decision-making on a single member. Nurses were expected to be empathetic and to gather information about the patient’s understanding of their condition and their family’s true feelings. Nurses aimed to protect the patient’s dignity and facilitate a peaceful end-of-life experience. Nurses also considered family care, including indirect involvement with families. Finally, nurses sought to understand doctors’ intentions, attitudes, and language and mediate the relationship between doctors and the family. Both physicians and nurses had shared as well as differing thoughts. We posit that mutual understanding and cooperation between physicians and nurses will lead to the implementation and enhancement of multifaceted family support. This comparative examination of physicians’ and nurses’ perspectives regarding family support in surrogate decision-making for end-of-life patients in the emergency room is not only novel but also contributes to the literature on interprofessional mutual understanding and collaboration in the healthcare context.