CWRU researcher searches for global views of nurses’ end-of-life care for patients

Photo of nurse comforting patientNurses will use extreme measures to save patients and their parents. But they’d prefer less aggressive life-preserving methods for themselves, according to an international survey on nurses’ end-of-life preferences.

Findings from a cross-cultural survey of 1,089 nurses from five countries about their end-of-life (EOL) preferences were reported in a recent issue of International Nursing Review.

“Globally, nurses chose different EOL treatments for themselves than they do for their patients,” said Joyce Fitzpatrick, the Elizabeth Brooks Ford Professor of Nursing at the Frances Payne Bolton School of Nursing and a lead investigator on the study.

While the study looked at preferences, the researchers asked why—if nurses chose this as best personal choice—isn’t it the one for the patients?

End-of-life preferences among physicians and families have been widely studied, but Fitzpatrick’s research group sought similar attitudes among nurses.

Nurses in Hong Kong, Ireland, Israel, Italy and the United States were given three hypothetical scenarios of dying patients to learn what they would do for the patient, their parents and themselves. The survey was conducted between June 2011 and July 2012.

The respondents were given the scenario of an 84-year-old male Alzheimer’s patient in a nursing home who had gastrointestinal bleeding, was in shock and likely to die without an intervention. Participants had to chose from one of four treatment options: palliative, limited, surgical or intensive care.

The scenario was repeated with the elderly patient as the survey-taker’s father. In the third scenario, they were to imagine themselves as that patient.

Most of the nurses in each country, from 55 percent in Hong Kong to 85 percent in the United States, responded that they would use CPR for patients and parents. But those numbers dropped on use for themselves.

Significant differences arose when asked about the use of feeding tubes. Just 19 percent of respondents in United States to 59 percent in Israel would use this intervention for themselves. But if the patients were their parents, the numbers would be double in some cases (40 percent to 75 percent, respectively).

Respondents globally reported that factors that influenced EOL preferences were: duty of care, lack of knowledge of the patient’s wishes, personal experiences with a dying family member, the patient’s age and lack of contact with the family. Fitzpatrick said the study contributes important information in developing global policies that provide patients with end-of-life choices.

“Making these decisions is complicated when the patient is unable to speak due to cognitive or medical problems,” Fitzpatrick said. “Then the hard and emotional decision is left to the family and health care professionals.”

The researchers report that end-of-life issues are in the midst of a global social debate, ranging from type of appropriate treatment to whom should make the ultimate decision, especially when differences arise between a doctor and family members.

For years, the decision, when a patient was unable to make it, was left to the doctor. But more countries—the United Kingdom, Australia, Canada, Israel, United States and several other European nations—have adopted the practice of leaving advance legal instructions.

Contributing to this study were:  Geraldine McCarthy, a Case Western Reserve University alumna, who organized the project; Elizabeth Weathers, Willie Molloy and Alice Coffee from Ireland; Piera Poletti and Renzo Zanotti from Italy; Sophia Chan and William Li Ho Cheung from Hong Kong; Mally Ehrenfeld and Michel Itzhaki from Israel; and Isabel Freidman and Kathleen Gallo from the U.S.