Abstract
Background:
All health care is underpinned by legal frameworks, including those that regulate who is responsible for healthcare decisions at the end of life. How these frameworks support decision-making in emergency departments (EDs) and intensive care units (ICUs) is underexplored.
Objective:
The objective of this study was to identify factors that help or hinder healthcare professionals' understanding and application of the law that applies to end-of-life decision-making in the EDs and ICUs in Queensland, Australia.
Methods:
A descriptive qualitative study based on naturalistic inquiry was undertaken. Participants were healthcare professionals working in the ICUs or EDs of one South East Queensland Hospital and Health Service, responsible for the care of adult patients who had died.
Results:
Thirteen medical practitioners, 19 registered nurses, and three social workers participated in semistructured interviews. Three themes and eight subthemes were identified in the data. First, the theme the complexity of communication is laid bare at the end of life described the challenges associated with talking about death and dying and the need to reframe conversations where death is inevitable. Next, the theme decision-making has layers highlighted family inclusion in decisions, navigating different perspectives to share decision-making and acknowledging that decision-making is emotionally burdensome. Finally, the theme how the law should apply is uncertain described the difficulties in deciding who should decide, knowing when Advance Health Directives can be relied on, and the need to reduce legal risk.
Conclusion:
Decision-making at the end of life is complex and challenging. Healthcare professionals charged with leading conversations find them challenging and are mindful of the burdens associated with such decisions. The need to work within the legal framework is acknowledged, but applying the law can be difficult.
All health care is underpinned by legal frameworks, including those that regulate who is responsible for healthcare decisions at the end of life. How these frameworks support decision-making in emergency departments (EDs) and intensive care units (ICUs) is underexplored.
Objective:
The objective of this study was to identify factors that help or hinder healthcare professionals' understanding and application of the law that applies to end-of-life decision-making in the EDs and ICUs in Queensland, Australia.
Methods:
A descriptive qualitative study based on naturalistic inquiry was undertaken. Participants were healthcare professionals working in the ICUs or EDs of one South East Queensland Hospital and Health Service, responsible for the care of adult patients who had died.
Results:
Thirteen medical practitioners, 19 registered nurses, and three social workers participated in semistructured interviews. Three themes and eight subthemes were identified in the data. First, the theme the complexity of communication is laid bare at the end of life described the challenges associated with talking about death and dying and the need to reframe conversations where death is inevitable. Next, the theme decision-making has layers highlighted family inclusion in decisions, navigating different perspectives to share decision-making and acknowledging that decision-making is emotionally burdensome. Finally, the theme how the law should apply is uncertain described the difficulties in deciding who should decide, knowing when Advance Health Directives can be relied on, and the need to reduce legal risk.
Conclusion:
Decision-making at the end of life is complex and challenging. Healthcare professionals charged with leading conversations find them challenging and are mindful of the burdens associated with such decisions. The need to work within the legal framework is acknowledged, but applying the law can be difficult.
| Original language | English |
|---|---|
| Article number | 101271 |
| Pages (from-to) | 1-7 |
| Number of pages | 7 |
| Journal | Australian Critical Care |
| Volume | 38 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - Sept 2025 |
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End-of-life decision-making in the emergency department and intensive care unit: Health professionals' perspectives on and knowledge of the law in Queensland
Hewitt, J., Alsaba, N., May, K., Kang, E., Cartwright, C., Willmott, L., White, B. & Marshall, A. P., Jun 2024, In: Emergency medicine Australasia : EMA. 36, 3, p. 429-435 7 p.Research output: Contribution to journal › Article › Research › peer-review
Open Access2 Link opens in a new tab Citations (Scopus) -
Emergency department and intensive care unit health professionals' knowledge and application of the law that applies to end-of-life decision-making for adults: A scoping review of the literature
Hewitt, J., Alsaba, N., May, K., Noon, H. S., Rennie, C. & Marshall, A. P., Jul 2023, In: Australian Critical Care. 36, 4, p. 628-639 12 p.Research output: Contribution to journal › Review article › Research › peer-review
5 Link opens in a new tab Citations (Scopus)
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