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Schefold, JC; Ruzzante, L; Sprung, CL; Gruber, A; Soreide, E; Cosgrove, J; Mullick, S; Papathanakos, G; Koulouras, V; Maia, PA; Ricou, B; Posch, M; Metnitz, P; Bülow, HH; Avidan, A, , ETHICUS, II, Study, Group.
The impact of religion on changes in end-of-life practices in European intensive care units: a comparative analysis over 16 years.
Intensive Care Med. 2023; 49(11):1339-1348 Doi: 10.1007/s00134-023-07228-z [OPEN ACCESS]
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Co-authors Med Uni Graz: Metnitz Philipp
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Abstract:: PURPOSE: Religious beliefs affect end-of-life practices in intensive care units (ICUs). Changes over time in end-of-life practices were not investigated regarding religions. METHODS: Twenty-two European ICUs (3 regions: Northern, Central, and Southern Europe) participated in both Ethicus-1 (years 1999-2000) and Ethicus-2 studies (years 2015-2016). Data of ICU patients who died or had limitations of life-sustaining therapy were analysed regarding changes in end-of-life practices and patient/physician religious affiliations. Frequencies, timing of decision-making, and religious affiliations of physicians/patients were compared using the same definitions. RESULTS: In total, 4592 adult ICU patients (n = 2807 Ethicus-1, n = 1785 Ethicus-2) were analysed. In both studies, patient and physician religious affiliations were mostly Catholic, Greek Orthodox, Jewish, Protestant, or unknown. Treating physicians (but not patients) commonly reported no religious affiliation (18%). Distribution of end-of-life practices with respect to religion and geographical regions were comparable between the two studies. Withholding [n = 1143 (40.7%) Ethicus-1 and n = 892 (50%) Ethicus-2] and withdrawing [n = 695 (24.8%) Ethicus-1 and n = 692 (38.8%) Ethicus-2] were most commonly decided. No significant changes in end-of-life practices were observed for any religion over 16 years. The number of end-of-life discussions with patients/ families/ physicians increased, while mortality and time until first decision decreased. CONCLUSIONS: Changes in end-of-life practices observed over 16 years appear unrelated to religious affiliations of ICU patients or their treating physicians, but the effects of religiosity and/or culture could not be assessed. Shorter time until decision in the ICU and increased numbers of patient and family discussions may indicate increased awareness of the importance of end-of-life decision-making in the ICU.
Find related publications in this database (using NLM MeSH Indexing): Adult - administration & dosage; Humans - administration & dosage; Terminal Care - methods; Withholding Treatment - administration & dosage; Intensive Care Units - administration & dosage; Religion - administration & dosage; Death - administration & dosage; Decision Making - administration & dosage
Find related publications in this database (Keywords): End of life; Intensive care units; Religion; Withholding life-sustaining treatments; Withdrawing life-sustaining treatments; Active shortening of the dying process