Expressions of Nonabandonment During the Intensive Care Unit Family Conference

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Abstract
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. 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. 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. 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.