1. Pengo et al.,
2016 [43]
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Italy
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1051
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288 doctors and 763 nurses.
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To examine the proportion of doctors and nurses who agree to antibiotics (AT), artificial hydration (AH), and artificial nutrition (AN) in patients with advanced dementia and variable life expectancy.
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Quantitative cross-sectional, questionnaire.
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1)When compared to other treatments like AH or AT, AN develops much more ethical problems in the medical management of end-of-life care.
2) For patients with a life expectancy of greater than one month, doctors were more likely than nurses to agree with AT.
3) Registered nurses on geriatric wards were much less likely to agree with the withdrawal of AH when life expectancy fell from 1–6 months to less than 1 month, reflecting on the limits of their profession when a patient died, believing that life itself need to be respected and that respect for a person's dignity plays an essential role in patient treatment.
4) Professional qualities, such as previous training, greatly influence health care workers' judgments on medical treatments for patients with severe dementia.
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Strengths
- Valuable information and also directions on an important and medically under-researched subject.
- The questionnaire was distributed to approximately 6000 physicians, nurses, and other members of staff work-
ing in all geriatric clinics, hospices and rest homes of two regions of northern Italy (Veneto and Trentino Alto- Adige), and one in central Italy (Marche).
- Respondents who completed in the questionnaire the specific items of interest to the present study were 1051: 288 were physicians and 763 nurses.
Weaknesses
- Because of the small number of regions studied, the results may be typical only of the situation in Northern and, to a lesser extent, Central Italy.
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Good
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https://pubmed.ncbi.nlm.nih.gov/27004847/
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2. Amoroso et al., 2017 [44]
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Greece
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66
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Doctors and nurses.
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To compare the perception of provision of futile treatment in the neuroscience intensive care unit (NSICU) amongst doctors, advanced practice providers, and intensive care unit registered nurses.
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Quantitative, standardized questionnaire.
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1) In half of the cases, NSICU clinicians consider the treatment they offer to be inappropriate for a loved one.
2) NSCIU medical professionals consider care futile in one-third of patients.
3) In 36 percent of patients, doctors and nurses noted futility.
4) Moral distress caused by futile treatment is a significant problem in the neuroscience intensive critical care team, and it has been linked to burnout.
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Strengths
- Futility was studied individually and in aggregate (yes/probably combined vs. no/probably combined).
- This research study contributes to the growing amount of evidence revealing that burnout and ethical distress are related.
Weaknesses
- Clinicians were asked to comment on futility within 48 hours of admission without having to rewrite the assessment.
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Good
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https://pubmed.ncbi.nlm.nih.gov/31469702/
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3. Fumis et al., 2017 [45]
|
Brazil
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283
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Intensive care unit (ICU) and also step-down unit (SDU) providers (doctors, nurses, nursing technicians, and respiratory therapists).
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To investigate the link between ethical distress as well as burnout in ICU.
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Quantitative, exploratory research using a self-administered questionnaire.
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1) Moral distress caused by therapeutic obstinacy and futile treatment is a significant problem in the critical care team, and it has been linked to severe burnout.
2) While depersonalization was similar across all professions, nurses (60 percent) had considerably higher rates of emotional exhaustion in the Maslach Burnout Inventory subscale than respiratory therapists, nurse technicians, or doctors.
3) Disputes arose mostly as a result of disagreements about treatment, moral issues, and end-of-life treatment.
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Strengths
- A large number of medical professionals were included, allowing a large number of people to participate.
- To maintain the confidentiality and anonymity of the participants, all staff who accepted to participate in this research study returned the questionnaire in a sealed envelope.
Weaknesses
- Limited to a single location, each with its own characteristics.
- If a sufficient number of invitees would have answered to the Moral Distress Scale-Revised, the results would have been different.
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Good
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https://pubmed.ncbi.nlm.nih.gov/28639161/
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4. Gulini et al., 2017 [46]
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Brazil
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37
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12 nurses, 11 nursing technicians, 5 physical therapists and 9 doctors
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To find out the perception of health specialists in a critical care unit towards palliative care.
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Qualitative study based on semi-structured interviews.
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1) Palliative care was seen as suitable in the last phase of life without the requirement for futile treatments or comfort procedures, according to the doctors.
2) Recognising the moment when a treatment is considered futile, or knowing when a particular intervention will not achieve the defined therapeutic goals of a particular patient, are complex processes.
3) Professionals confuse palliative care with end-of-life care
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Strengths
- Participants were selected since the research study centered on palliative care patients with pain, dyspnea, and hypersecretion, and these professional categories are directly involved in alleviating such symptoms in the intensive care unit.
Weaknesses
- This study was conducted in only one ICU.
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Moderate
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https://www.scielo.br/j/reeusp/a/XJH7HjzN8m4XzXMD7dGvSmw/?lang=en
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5. Aghabarary et al., 2017 [47]
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Iran
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30
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21 nurses and 9 doctors.
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To investigate the perceptions of reasons for futile medical treatments by Iranian registered nurses and doctors.
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Qualitative semi-structured personal interview.
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1) Several personal and also organizational factors contribute to futile medical treatments.
2) Raising the number of palliative treatment centers and hospices along with educating health professionals, patients, and relatives about the services and benefits of such centers can help ensure that wise decisions are made about continuing or discontinuing treatments that are considered futile.
3) In Iran, due to various personal and organizational circumstances, health professionals are obliged to perform certain treatments even though they know they are futile.
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Strengths
- Recognizes and also talks about complexities of the ICU registered nurse’s roles, in regards to end-of-life care.
Weaknesses
- Small number of subjects, so these results may not be representative of ICU nurses in general.
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Good
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https://pubmed.ncbi.nlm.nih.gov/27000190/
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6. Laurent et al., 2017 [48]
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Canada
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20
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10 doctors and 10 nurses.
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The goal of this study was to better understand exactly how emotions influence the end-of-life decision-making process among ICU professionals.
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Qualitative study with clinical interviews.
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1) Registered nurses' feelings toward their patients as well as doctors' feelings toward their patients' families influence the end-of-life decisions they make during the end-of-life decision making process.
2) The lack of a decision to terminate or limit treatment is the primary source of nurses' displeasure with end-of-life decisions.
3) Collegial decision-making in end-of-life scenarios is difficult due to the varied responsibilities and moral motivations that health care providers have.
4) Despite the fact that end-of-life decisions can be contentious, doctors recognize the necessity of involving caregivers in the decision-making process because it allows them to preserve consistency and credibility with their patients' families.
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Strengths
- The professionals who were interviewed had worked in the ICU for more than 4 years, and the nurses regularly attended end-of-life decision-making meetings, as well as patient rounds and/or meetings with patients' families.
Weaknesses
- The short sample sizes
- This study was conducted in two ICUs within a single hospital and a single province.
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Moderate
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https://pubmed.ncbi.nlm.nih.gov/28938252/
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7. Chamberlin et al., 2019 [49]
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USA
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349
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Nurses, physician assistants, nurse practitioners, attending doctors, residents, and fellows.
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Examine the causes of futile/ potentially inappropriate care (PIC), determine whether clinicians report compensatory or avoidant behaviors as a result of such treatment, and assess whether these behaviors are associated with burnout.
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Quantita-tive online cross-sectional self-administered, online questionnaire.
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1) Clinician self-report of providing futile/PIC was significantly associated with both compensatory and avoidant behaviors.
2) Futile/PIC, provided or observed, is associated with avoidance of patients, families, and colleagues and those behaviors are associated with burnout.
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Strengths
– A large group of doctors and nurses were included, allowing for a wide range of participants.
- Participants were from two academic hospitals so not all participants knew each other.
- An anonymous survey.
Weaknesses
– Only a 19.6% response rate was obtained, which includes the possibility of nonresponse bias.
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Good
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6735323/
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8. Leuter et al., 2020 [50]
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Italy
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479
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351 nurses and 128 doctors from four university hospitals in the Abruzzo region. Three of the hospitals provide ethically sensitive services, such as abortions, intensive care, oncological treatments and palliative care.
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To investigate how Italian nurses and doctors view end-of-life issues and whether there are differences between them, a secondary analysis of existing data from a cross-sectional study was conducted.
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Quantita-tive cross-sectional questionnaire.
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1) In defining futility, registered nurses concentrated primarily on agony, suffering, and risk, while doctors paid more attention to the hope of treatment.
2) However, both were concerned regarding different aspects of treatments, particularly nurses about the "invasiveness of treatments" and doctors about the "overmedicalization of death."
3) Instead, nurses and doctors similarly acknowledged patients' right to anticipate the end of life when terminally ill and to freely express their wish not to be resuscitated.
4) Both nurses and doctors acknowledged the need to respect the patient's will in end-of-life treatment, even if they were uncertain whether the implementation of such a will could be guaranteed.
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Strengths
- This is the first Italian research study involving nurses and doctors regarding their experiences and points of views on ethical concerns.
- This experience could be a starting point to stimulate research activities on this topic and contribute to take into account the opinions of health care providers in the development of practical guidelines for end-of-life treatments.
Weaknesses
- A highly shared definition of futility is still lacking.
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Good
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https://pubmed.ncbi.nlm.nih.gov/32266365/
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