As the science progresses related to families participating in the process of withdrawal of life-sustaining therapy (LST), it is important to assess research accomplishments, identify gaps in the knowledge and ways to build on the science, and suggest new directions for future research. Research-based articles related to families participating in the process of withdrawal of LST were obtained by conducting computer-assisted searches and analyzing references lists. A grid was developed that included key variables from each of the studies. A second grid was developed and included the subthemes that evolved from the analysis. Eleven studies were reviewed and analyzed. Themes that evolved include illness context, family context, and family and health care provider interactions. Important information has been discovered about the family decision-making process and helpful health care provider interactions. Additional research focused on withdrawal of LST is needed to understand important concepts, develop instruments, and test interventions.
Faber-Langendoen, K. (1996). A multi-institutional study of care given to patients dying in hospitals: Ethical and practice implications. Archives of Internal Medicine, 156(18), 2130-2136.
2.
Feetham, S. L. (1991). Conceptual and methodological issues in research of families. In A. L. Whall & J. Fawcett (Eds.), Family theory development in nursing: State of the science and art (pp. 55-68). Philadelphia: F. A. Davis.
3.
Hansen, L., Archbold, P. G., & Stewart, B. J. (2004). Role strain and ease in decision-making to withdraw or withhold life support for elderly relatives. Journal of Nursing Scholarship, 36(3), 233-238.
4.
Jacob, D. A. (1998). Family members’ experiences with decision making for incompetent patients in the ICU: A qualitative study. American Journal of Critical Care, 7(1), 30-36.
5.
Keenan, S. P., Busche, K. D., Chen, L. M., Esmail, R., Inman, K. J., & Sibbald, W. J. (1998). Withdrawal and withholding of life support in the intensive care unit: A comparison of teaching and community hospitals. Critical Care Medicine, 26(2), 245-251.
6.
Keenan, S. P., Busche, K. D., Chen, L. M., McCarthy, L., Inman, K. J., & Sibbald, W. J. (1997). A retrospective review of a large cohort of patients undergoing the process of withholding or withdrawal of life support. Critical Care Medicine, 25(8), 1324-1331.
7.
Kolleff, M. H. (1996). Private attending physician status and the withdrawal of life-sustaining interventions in a medical intensive care population. Critical Care Medicine, 24(6), 968-975.
8.
Lynn-McHale, D. J., & Deatrick, J. A. (2000). Trust between family and health care providers. Journal of Family Nursing, 6(3), 210-230.
9.
Mayer, S. A., & Kossoff, S. B. (1999). Withdrawal of life support in the neurological intensive care unit. Neurology, 52(8), 1602-1609.
10.
McCue, J. D. (1995). The naturalness of dying. Journal of the American Medical Association, 273(13), 1039-1043.
11.
McLean, R. F., Tarshis, J., Mazer, C. D., & Szalai, J. P. (2000). Death in two Canadian intensive care units: Institutional difference and changes over time. Critical Care Medicine, 28(1), 100-103.
12.
Norton, S. A., Tilden, V. P., Tolle, S. W., Nelson, C. A., & Eggman, S. T. (2003). Life support withdrawal: Communication and conflict. American Journal of Critical Care, 12(6), 548-555.
13.
O’Callahan, J. G., Fink, C., Pitts, L. H., & Luce, J. M. (1995). Withholding and withdrawing of life support from patients with severe head injury. Critical Care Medicine, 23(9), 1567-1575.
14.
Oliverio, R., & Fraulo, B. (1998). SUPPORT revisited: The nurse clinician’s perspective. Holistic Nurse Practice, 13(1), 1-7.
15.
Prendergast, T. J. (2000). Withholding or withdrawal of life-sustaining therapy. Hospital Practice, 35(6), 91-102.
16.
Prendergast, T. J., Claessens, M. T., & Luce, J. M. (1998). A national survey of end-of-life care for critically ill patients. American Journal of Respiratory and Critical Care Medicine, 158(4), 1163-1167.
17.
Prendergast, T. J., & Luce, J. M. (1997). Increasing incidence of withholding and withdrawal of life support from the critically ill. American Journal of Respiratory and Critical Care Medicine, 155(1), 15-20.
18.
Reckling, J. (1997). Who plays what role in decisions about withholding and withdrawing life-sustaining treatment?Journal of Clinical Ethics, 8(1), 39-45.
19.
Roberts, J. C., Snyder, R., & Kjellstrand, C. M. (1988). Withdrawing life support—the survivors. Acta Medica Scandinavica, 224(2), 141-148.
20.
Swigart, V., Lidz, C., Butterworth, V., & Arnold, R. (1996). Letting go: Family willingness to forgo life support. Heart & Lung: The Journal of Acute and Critical Care, 25(6), 483-494.
21.
Tilden, V. P., Tolle, S. W., Garland, M. J., & Nelson, C. A. (1995). Decisions about life-sustaining treatment: Impact of physicians’ behavior on the family. Archives of Internal Medicine, 155(6), 633-638.
22.
Tilden, V. P., Tolle, S. W., Nelson, C. A., & Fields, J. (2001). Family decision-making to withdraw life-sustaining treatments from hospitalized patients. Nursing Research, 50(2), 105-115.
23.
Tilden, V. P., Tolle, S. W., Nelson, C. A., Thompson, M., & Eggman, S. C. (1999). Family decision making in foregoing life-extending treatments. Journal of Family Nursing, 5(4), 426-442.
24.
Wiegand, D. L. (2003). Family experiences participating in the process of withdrawal of life sustaining therapy. Unpublished doctoral dissertation, University of Pennsylvania.
