Physicians’ perceptions of end-of-life decision-making in the adult intensive care unit: A qualitative study

Abstract

Background. End-of-life (EOL) decision-making in the intensive care unit (ICU) is a complex and ethically demanding process requiring the integration of medical judgement, ethical principles and emotional sensitivity. Physicians initiate and lead these decisions, particularly in determining the appropriateness and limits of life-saving interventions. In South Africa (SA), systemic challenges, such as communication barriers and resource limitations, further complicate these decisions. There is limited research exploring physicians’ perspectives on EOL decision-making in adult ICUs. Objective. To explore physicians’ perceptions of EOL decision-making in an adult ICU in SA. Methods. An exploratory, descriptive qualitative design was used. Semi-structured interviews were conducted with nine purposively sampled physicians from a multidisciplinary adult ICU in a Johannesburg tertiary hospital. Data were transcribed verbatim and analysed using inductive thematic analysis. Results. Three major themes emerged: collaborative decision-making, communication with families and emotional detachment v. burden. The decision to limit life-sustaining treatment is a complex and collaborative process that requires effective communication with patients’ families. However, emotional responses, including detachment and burden, arose when navigating the decision-making process. Conclusions. EOL decision-making in ICUs is complex and emotionally demanding for physicians, shaped by ethical dilemmas and communication challenges. Addressing these challenges is vital to creating a more supportive environment for healthcare professionals. This study emphasises the importance of clearer interprofessional collaboration, particularly between nurses and physicians, in the decision-making process.