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VOLUME 20 , ISSUE 8 ( 2016 ) > List of Articles


Experiences in end-of-life care in the Intensive Care Unit: A survey of resident physicians

Charu Singh, Fazil Muhammed, Abish Sudhakar

Keywords : End-of-life, intensive care, palliative care

Citation Information : Singh C, Muhammed F, Sudhakar A. Experiences in end-of-life care in the Intensive Care Unit: A survey of resident physicians. Indian J Crit Care Med 2016; 20 (8):459-464.

DOI: 10.4103/0972-5229.188196

License: CC BY-ND 3.0

Published Online: 01-08-2016

Copyright Statement:  Copyright © 2016; The Author(s).


Background and Aims: The practice of intensive care includes withholding and withdrawal of care, when appropriate, and the goals of care change around this time to comfort and palliation. We decided to survey the attitudes, training, and skills of intensive care residents in relation to end-of-life (EoL) care. All residents at our institute who has worked for at least a month in an adult Intensive Care Unit were invited to participate. Materials and Methods: After Institutional Ethics Committee approval, a Likert-scale questionnaire, divided into five composite measures of EoL skills including training and attitude, was handed over to individual residents and completed data were anonymized. Frequency and descriptive analysis was performed for the demographic variables. Central tendency, variability, and reliability were examined for the five composite measures. Scale internal consistency was checked by Cronbach′s coefficient alpha. Multivariate forward conditional regression analysis was conducted to examine the association of demographic data or EoL experience to composite measures. Results: Of the 170 eligible residents, we received 120 (70.5%) responses. Conclusions: Internal medicine residents have more experience in caring for dying patients and conducting EoL discussions. Even though majority of participants reported that they are comfortable with the concept of EoL care, this does not always reflect the actual practice in the hospital. There is a need for further training in skills around EoL care. As this is a self-assessment survey, the specific measures of attitudes and skills in EoL are poorly reflected, indicating a need for further research.

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  1. Ferrand E, Robert R, Ingrand P, Lemaire F; French LATAREA Group. Withholding and withdrawal of life support in intensive-care units in France: A prospective survey. French LATAREA Group. Lancet 2001;357:9-14.
  2. Sprung CL, Cohen SL, Sjokvist P, Baras M, Bulow HH, Hovilehto S, et al. End-of-life practices in European intensive care units: The Ethicus Study. JAMA 2003;290:790-7.
  3. Mani RK, Amin P, Chawla R, Divatia JV, Kapadia F, Khilnani P, et al. Guidelines for end-of-life and palliative care in Indian intensive care units′ ISCCM consensus Ethical Position Statement. Indian J Crit Care Med 2012;16:166-81.
  4. Myatra S, Salins N, Iyer S, Macaden S, Divatia J, Muckaden M, et al. End-of-life care policy: An integrated care plan for the dying. Indian J Crit Care Med 2014;18:615-21.
  5. Divatia JV, Iyer S. Ten major priorities for intensive care in India. Intensive Care Med 2015;41:1468-71.
  6. Indian Society of Critical Care Medicine; 2014. Available from: [Last accessed on 2016 Jan 15].
  7. Iyer S. Challenges in the implementation of end-of-life care guidelines in India: How to open the Gordian knot? Indian J Crit Care Med 2014;18:563-4.
  8. Chen E, McCann JJ, Lateef OB. Attitudes toward and experiences in end-of-life care education in the intensive care unit: A survey of resident physicians. Am J Hosp Palliat Care 2015;32:738-44.
  9. Hayslett MM, Wildemuth BM. Pixels or pencils? The relative effectiveness of Web-based versus paper surveys. Libr Inf Sci Res 2004;26:73-93.
  10. Draugalis JR, Coons SJ, Plaza CM. Best practices for survey research reports: A synopsis for authors and reviewers. Am J Pharm Educ 2008;72:11.
  11. Huston P. Reporting on surveys: Information for authors and peer reviewers. CMAJ 1996;154:1695-704.
  12. Mani RK. Coming together to care for the dying in India. Indian J Crit Care Med 2014;18:560-2.
  13. Murray S. The quality of death: Ranking end-of-life care across the world. Economic Intelligence Unit. [Last accessed 2016 Aug 04].
  14. Anderson PA. Giving feedback on clinical skills: Are we starving our young? J Grad Med Educ 2012;4:154-8.
  15. Shrivastava SR, Shrivastava PS, Ramasamy J. Effective feedback: An indispensable tool for improvement in quality of medical education. J Pedagog Dev 2014;4:12-20.
  16. Algiraigri AH. Ten tips for receiving feedback effectively in clinical practice. Med Educ Online 2014;19:25141.
  17. Sprung CL, Maia P, Bulow HH, Ricou B, Armaganidis A, Baras M, et al. The importance of religious affiliation and culture on end-of-life decisions in European intensive care units. Intensive Care Med 2007;33:1732-9.
  18. Phua J, Joynt GM, Nishimura M, Deng Y, Myatra SN, Chan YH, et al. Withholding and withdrawal of life-sustaining treatments in intensive care units in Asia. JAMA Intern Med 2015;175:363-71.
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