Simon Oczkowski|Harold M. Chung|Louise Hanvey|Lawrence Mbuagbaw|John J. You
Communication tools for end-of-life decision-making in the intensive care unit: a systematic review and meta-analysis
McMaster University|McMaster University|Canadian Hospice Palliative Care Association|McMaster University|McMaster University
many patients admitted intensive care unit icu preferences endoflife care unknown clinicians substitute decisionmakers required make decisions goals care behalf conducted systematic review determine effect structured communication tools endoflife decisionmaking compared usual care upon number documented goals care discussions documented code status decisions withdraw lifesustaining treatments adult patients admitted icuwe searched multiple databases including medline embase cinahl eric cochrane database inception july 2014 two reviewers independently screened articles assessed eligibility verified data extraction assessed risk bias using tool described cochrane collaboration newcastle ottawa scale pooled estimates effect relative risk standardized mean difference mean difference calculated sufficient data existed grade used evaluate overall quality evidence outcomewe screened 5785 abstracts reviewed full text 424 articles finding 168 eligible articles including 19 studies icu setting use communication tools increased documentation goalsofcare discussions rr 347 95 ci 155 775 p 0020 lowquality evidence effect code status documentation rr 103 95 ci 096 110 p 0540 lowquality evidence decisions withdraw withhold lifesustaining treatments rr 098 95 ci 089 108 p 070 lowquality evidence use tools associated decrease multiple measures health care resource utilization including duration mechanical ventilation md 19 days 95 ci 326 054 p 0006 lowquality evidence length icu stay md 111 days 95 ci 218 003 p 004 lowquality evidence health care costs smd 032 95 ci 05 015 p 0001 lowquality evidencestructured communication tools may improve documentation eol decision making may result lower resource use supporting evidence low low quality highquality randomized studies simple communication interventions needed determine whether structured rather ad hoc approaches endoflife decisionmaking improve patientlevel familylevel systemlevel outcomesprospero crd42014012913