icu

Preparation of Those With a Stake in the Process

　　 Patients, family, and other loved ones; medical and nursing staff; pastoral caregivers; and other supportive caregivers all have an interest in ensuring high-quality end-of-life care. Of all these groups, it is the patient who should have the most input into the decision-making process. This is often not possible in the ICU, where sudden events may have taken place before a patient's wishes were clearly known. Singer and colleagues[4] identified 5 factors that patients felt were important:
　

Symptom control;
　

Avoidance of a prolonged dying process;
　

Return of control and authority;
　

Relieving burden; and
　

Strengthening links with loved ones.
　　Families require to be present, helpful, informed and heard.[5] They also need their own support and will need reassurance that the correct decisions have been made. On a practical note, they need to be rested, fed, and watered. For the care team, this is a time for the leader to "step up to the plate" and lead by involved example. This can send a powerful message to the family and other staff that the physician in charge of the ICU care process is intimately involved, approves, and is taking an active role in delivery of care. The team should be multidisciplinary in make up, and a controversial study reported in 1996[6] highlighted the possible ways that this process may go awry if left unmanaged or led by weak leadership.