Table 2.
Study characteristics
| Study ID | Sample size | Population description | Country | Design | Target of intervention | Intervention | Comparator | Measured outcome |
|---|---|---|---|---|---|---|---|---|
| Andereck 2014 [14] | Intervention 174, control 210 | Patients admitted to the medical or surgical ICU of a tertiary care hospital for at least 5 consecutive days | USA | RCT | Family/SDM | The intervention group received a proactive ethics consultation. The ethics consultation assessed patient capacity and preferences, and assisted SDMs in medical decision-making, including DNR. The ethicist continued to follow the patient until discharge | Usual care | • Health care resource utilization • Satisfaction with end-of-life care |
| Lautrette 2007 [21] | Intervention 63, control 63 | Adult patients admitted to medical or surgical ICUs judged to be likely to die within a few days, with an identified SDM | France | RCT | Family/SDM | An intensive end-of-life communication intervention aimed at eliciting the patient’s values, acknowledging the family member’s voice and emotions, and to allow questions. Following the meeting, families were given a brochure on bereavement | Usual care | • Quality of communication • Preference on life-sustaining treatment options • Advance directive discussions • Health care resource utilization |
| Schneiderman 2000 [23] | Intervention 35, control 35 | ICU patients in whom value-based treatment conflicts arose (e.g., disagreements over CPR status, withdrawal of life support, etc.) | USA | RCT | Family/SDM | Offering of an ethics consultation from the hospital ethics service | Usual care | • Health care resource utilization • Preference on life-sustaining treatment options • Acceptability of intervention |
| Schneiderman 2003 [24] | Intervention 278, control 273 | Critically ill adult patients admitted to medical or surgical ICUs | USA | RCT | Family/SDM | The intervention group received a proactive ethics consultation, which addressed current ethical issues, reviewed patient wishes and values, and provided recommendations for next steps regarding communication and decision-making | Usual | • Health care resource utilization • Acceptability of intervention |
| Ahrens 2003 [32] | Intervention 43, control 108 | Patients admitted to an academic tertiary care medical ICU | USA | Cohort | Family/SDM | Families/SDMs were provided with an intensive communication strategy, including daily medical updates by the attending physician, provision of treatment options, including non-curative/palliative options, and support by a clinical nurse specialist | Usual care | • Health care resource utilization |
| Campbell 2003 [29] | Intervention 20, control 18 | Patients admitted to the medical ICU with either global cerebral ischemia or multisystem organ failure, with a retrospective control cohort and prospective interventional cohort | USA | Cohort | Family/SDM | Early involvement of palliative care service in communicating prognosis to the family, identifying advance directives and preference, and assisting with discussion and implementation of treatment options and palliative care | Usual care | • Preference on life-sustaining treatment options • Health care resource utilization |
| Cox 2012 [15] | Intervention 10, control 17 | SDMs for adult medical and surgical ICU patients on mechanical ventilation for equal to or greater than 10 days, expected to survive for greater than 72 hours without pre-existing tracheostomy | USA | Cohort | Family/SDM | The prolonged mechanical ventilation decision aid reviewed medical information, elicited the SM understanding of the patient’s preferences, clarified the role of the SDM, and provided guidance in decision-making | Usual care | • Quality of communication • Comfort and confidence (decision conflict) • Health care knowledge and literacy • Health care resource utilization • Preference on life-sustaining treatment options |
| Daly 2010 [16] | Intervention 354, control 135 | Incapable patients with 72 hours of mechanical ventilation, with an identified SDM, admitted to surgical, medical, or neuroscience ICUs at two university-affiliated medical centers | USA, Canada | Cohort | Family/SDM | An intensive communication system, including a family meeting with a medical update, identification of goals of care, a treatment plan, and milestones for determining if the treatment was effective, conducted within 5 days of ICU admission and weekly thereafter. | Usual care | • Preference on life-sustaining treatment options • Health care resource utilization • Quality of communication |
| Dowdy 1998 [17] | Intervention 31, control 31 | Sequential patients treated with mechanical ventilation for more than 96 hours, between June 1992 and October 1994 | USA | Cohort | Family/SDM | Proactive ethics consultation, and daily as required, addressing advance directives, patient capacity, SDM knowledge of patient advance directive, anticipated conflicts, and limits of treatment | Usual care | • Preference on life-sustaining treatment options • Health care resource utilization • Quality of communication |
| Hatler 2012 [18] | Intervention 98, control 105 | Patients admitted to a territory neurosurgical ICU who received mechanical ventilation for >96 hours, remained in ICU for 7 days or longer, and were not awaiting transfer out of ICU during that time | USA | Cohort | Family/SDM and HCPs | A surrogacy information and decision-making tool was filled out by the admitting nurse, documenting patient’s decision-making capacity, the identity of the SDM/POA, and prior advance directive. The nurse gave the patient or SDM an information sheet about surrogate decision-making and advance directives. | Usual care | • Health care resource utilization |
| Holloran 1995 [28] | Intervention 6, control 24 | Patients admitted to a large, tertiary care ICU for any reason. | USA | Cohort | HCPs | “Decisions near the End of Life” program, a small-group workshop using cases to facilitate discussion of issues such as withholding or withdrawing treatment, eliciting patient and family wishes, patient competency, and conflict with families | Pre-intervention hospital cohort | • Health care resource utilization • Preference on life-sustaining treatment options |
| Knaus 1990 [25] | Intervention 705, control 760 | All adult patients admitted to ICU, excluding those with uncomplicated myocardial infarction or those admitted with acute burns | France | Cohort | HCPs | HCPs were provided with a calculated estimate of hospital mortality daily on rounds until the patient died, or until 7 days, whichever came first | Usual care | • Preference on life-sustaining treatment options |
| Lamba 2012 [27] | Intervention 104, control 79 | Patients admitted to a surgical ICU between March 2003 and May 2005 for liver transplantation | USA | Cohort | Family/SDM | Each patient had a palliative care assessment delineating prognosis, advance directives, family support, surrogate decision maker, and pain, within 24 hours of admission. The patient’s family received psychosocial and/or bereavement support. An interdisciplinary family meeting was held at 72 hours to address patient outcomes, treatment options, and goals of care, and family support was provided by a multidisciplinary team. | Usual care | • Quality of communication • Preference on life-sustaining treatment options • Advance directive discussions • Health care resource utilization |
| Lilly 2000 [26] | Intervention 396, control 134 | Consecutive admitted to the ICU of a tertiary care teaching hospital | USA | Cohort | Family/SDM | An intensive communication strategy, including a meeting with the attending physician within 72 hours for patients expected to stay >4 days, with predicted mortality >25 %, or change in functional status, unlikely to return to home | Usual care | • Advance directive discussions • Quality of communication • Health care resource utilization |
| McCannon 2012 [30] | Intervention 27, control 23 | Patients admitted to the medical ICU age >50 years, currently incapable, likely to survive >24 hours, with an identified adult SDM. | USA | Cohort | Family/SDM | A 3-minute video decision support-tool was shown which reviewed CPR methods and outcomes, and the care of a sedated, mechanically ventilated patient, within 72 hours of ICU admission | Usual care | • Health care knowledge and literacy • Preference on life-sustaining treatment options • Acceptability of intervention |
| Norton 2007 [19] | Intervention 126, control 65 | Adult patients admitted to a medical ICU with a hospital stay of 10 days, age >80 years, or two or more life-threatening comorbidities | USA | Cohort | Family/SDM | The intervention group had a proactive palliative care consultation, which facilitated decision-making and family member support, and followed the patient until discharge | Usual | • Health care resource utilization |
| Quenot 2012 [31] | Intervention 823, control 678 | All patients who died in the ICU, or in hospital after discharge to another department, during two periods, one before and one after a 2005 French law on end-of-life and patient rights. | France | Cohort | Family/SDM | An intensive communication strategy, including daily meetings with the attending team, modalities for withdrawing and withholding treatment, a special ‘ethics’ section in the chart, and debriefing sessions | Pre-intervention hospital cohort | • Preference on life-sustaining treatment options • Health care resource utilization • Quality of communication |
| Shelton 2010 [20] | Intervention 114, control 113 | Patients admitted to the surgical ICU, anticipated by the attending physician to remain for at least 7 days, or were expected to die within that time, during two periods | USA | Cohort | Family/SDM | During the intervention period, a family support coordinator assessed the family’s information needs, interpreted and explained relevant medical information, assisted the family in decision-making, and identified the need for referrals to spiritual care and to enhance the health care team’s understanding of the family’s needs. | Usual care | • Satisfaction with end-of-life care • Quality of communication with HCPs • Health care resource utilization |
| Curtis 2011 [22] | Intervention 514, control 565 | Medical and surgical ICUs with sufficient ICU deaths to meet study sample size requirements (6 intervention hospitals, 6 control hospitals) Patients included those who died in ICU or within 30 hours of transfer to another hospital location. | USA | Cluster RCT | HCPs | A multifaceted intervention including education about palliative care, identification and training of ICU clinician local champions for palliative care, nurse and physician ICU directors to address barriers to improving end-of-life care, feedback of quality data including family satisfaction, and implementation of system supports such as palliative care order forms. | Usual care | • Satisfaction with end-of-life care • Preference on life-sustaining treatment options • Quality of communication • Health care resource utilization |
RCT randomized controlled trial, SDM substitute decision-maker, CRP cardiopulmonary resuscitation, HCP health care provider