The decision-making process of transferring patients home to die from an intensive care unit in mainland China: A qualitative study of family members’ experiences
The decision-making process of transferring patients home to die from an intensive care unit in mainland China: A qualitative study of family members’ experiences
Objectives: To map the decision-making process of family members involved in transferring a critically ill patient home to die from an intensive care unit in mainland China and to explore the experiences of those family members. Design: A constructivist qualitative study. Setting: One hospitals intensive care unit in Southeast China. Methods: Thirteen adult family members (of ten patients) who participated in decision-making related to transferring a relative home to die from the intensive care unit were purposively selected. Data were collected via interviews and analysed applying thematic analysis. Findings: A two-stage decision-making process was identified. Family decision-making was mediated by factors including: accepting the impending death and hope that the patient would not die; time pressures in which decisions had to be made, and the challenges of meeting cultural expectations of a home death. Transfer home was a family-centred decision constrained by a gender-based hierarchy restricting the involvement of different family members. Conclusion: The stages and key factors in the decision-making process of family members when involved in transferring a patient home to die from an intensive care unit in China are rooted and informed by cultural expectations and limits in the current healthcare system regarding end-of-life care options. Understanding the climate in which family members must make decisions will facilitate supportive interventions to be implemented by healthcare professionals. Further empirical research is needed to explore family members’ needs when the patient has been transferred and dies at home in mainland China. Implications for Clinical Practice: Healthcare professionals need to understand the challenges family members face when deciding to transfer a relative home to die from an intensive care unit. For example time pressures can limit the choices of family members so that to provide them with timely, ongoing, realistic updates for a greater involvement of family members in generating end of life care plans could be beneficial.
1
Critical care, Decision-making, End of life care, Family members, Patient transfer, Qualitative research, Transfer home to die
Lin, Yanxia
962dcabe-7d8a-45c3-b716-08c1f953e7ab
Long-sutehall, Tracy
92a6d1ba-9ec9-43f2-891e-5bfdb5026532
Myall, Michelle
0604ba0f-75c2-4783-9afe-aa54bf81513f
June 2023
Lin, Yanxia
962dcabe-7d8a-45c3-b716-08c1f953e7ab
Long-sutehall, Tracy
92a6d1ba-9ec9-43f2-891e-5bfdb5026532
Myall, Michelle
0604ba0f-75c2-4783-9afe-aa54bf81513f
Lin, Yanxia, Long-sutehall, Tracy and Myall, Michelle
(2023)
The decision-making process of transferring patients home to die from an intensive care unit in mainland China: A qualitative study of family members’ experiences.
Intensive and Critical Care Nursing, 76, [103399].
(doi:10.1016/j.iccn.2023.103399).
Abstract
Objectives: To map the decision-making process of family members involved in transferring a critically ill patient home to die from an intensive care unit in mainland China and to explore the experiences of those family members. Design: A constructivist qualitative study. Setting: One hospitals intensive care unit in Southeast China. Methods: Thirteen adult family members (of ten patients) who participated in decision-making related to transferring a relative home to die from the intensive care unit were purposively selected. Data were collected via interviews and analysed applying thematic analysis. Findings: A two-stage decision-making process was identified. Family decision-making was mediated by factors including: accepting the impending death and hope that the patient would not die; time pressures in which decisions had to be made, and the challenges of meeting cultural expectations of a home death. Transfer home was a family-centred decision constrained by a gender-based hierarchy restricting the involvement of different family members. Conclusion: The stages and key factors in the decision-making process of family members when involved in transferring a patient home to die from an intensive care unit in China are rooted and informed by cultural expectations and limits in the current healthcare system regarding end-of-life care options. Understanding the climate in which family members must make decisions will facilitate supportive interventions to be implemented by healthcare professionals. Further empirical research is needed to explore family members’ needs when the patient has been transferred and dies at home in mainland China. Implications for Clinical Practice: Healthcare professionals need to understand the challenges family members face when deciding to transfer a relative home to die from an intensive care unit. For example time pressures can limit the choices of family members so that to provide them with timely, ongoing, realistic updates for a greater involvement of family members in generating end of life care plans could be beneficial.
1
Other
RE Manuscript accepted for publication
- Accepted Manuscript
More information
Accepted/In Press date: 18 January 2023
e-pub ahead of print date: 1 February 2023
Published date: June 2023
Additional Information:
Funding Information:
This study was funded by China Scholarship Council (CSC) (No.: 201409350009) as part of YL’s Doctoral studies.
Publisher Copyright:
© 2023 Elsevier Ltd
Keywords:
Critical care, Decision-making, End of life care, Family members, Patient transfer, Qualitative research, Transfer home to die
Identifiers
Local EPrints ID: 475312
URI: http://eprints.soton.ac.uk/id/eprint/475312
ISSN: 0964-3397
PURE UUID: aab9043c-ac3b-4e9b-908b-76fc624b661e
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Date deposited: 15 Mar 2023 17:35
Last modified: 17 Mar 2024 07:41
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Author:
Yanxia Lin
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