Ethicus 2
Research type
Research Study
Full title
End-of-life practices in intensive care units around the world- The Ethicus II study
IRAS ID
173100
Contact name
Christopher Bassford
Contact email
Sponsor organisation
University Hospitals Coventry and Warwickshire NHS Trust
Duration of Study in the UK
0 years, 5 months, 31 days
Research summary
Admission to an intensive care unit (ICU) allows patients with severe injuries and illnesses access to potentially life saving therapy. Unfortunately, despite this care, 1 in 5 patients admitted to an ICU do not survive. It is universally acknowledged that dying patients should be treated compassionately, the form that this care takes is known to be different around the world.
The Ethicus study reported its findings in 2003. This was a large multi-center study which described the actual end of life practices in 37 ICUs in 17 European countries, and provided valuable information on the care received by patients on intensive care units at the end of their lives. This study showed that there were important differences in care received by patients between different areas of Europe; and that care given to patients varied depending on the patient, the physician, the institutional characteristics, and by religion and religiosity of those involved. This study also showed the extent to which end-of-life decisions were discussed with patients and family members and the variation in practice in this regard. This study investigated the prevalence of the withholding of care (not providing an aspect of clinical care, such as invasive ventilation), the withdrawal of care (removing care that has previously been started), and whether there is active shortening of the dying process (treatment administered with the aim of hastening death). Although this latter practice is clearly illegal in the UK, it is seen internationally.
As 15 years have passed since the original Ethicus study and there have been changes in end-of-life care in Europe and around the world, we believe it is important to repeat the so we can evaluate the extent of changes in end-of-life practices. This study will test the hypotheses that: 1. There has been a change in end of life practices over the last 15 years from the time the first Ethicus study was performed, primarily the southern European sites with more limitations and not the northern centers which already had a high percentages of limitations; and 2. There are still regional (and even country) differences in end of life practices based on culture, religion and religiosity.
To investigate this aspect of care for critically ill patients we will conduct an international multi-center study, coordinated by an international team based in Israel. Participating intensive care units will complete an anonymised questionnaire for all patients who have died on their ICU, or for whom a decision has been made to limit supportive care. This information will then be analysed at the coordinating center and comparisions made to practices around the world.
This study will provide valuable information on how patients are cared for at the end of their lives both in the UK and around the world. This information will inform policy makers, researchers and patient groups on how care is provided to them and what factors affect their care. This will help to improve the care received by critically ill patients around the world.
REC name
West Midlands - Coventry & Warwickshire Research Ethics Committee
REC reference
15/WM/0112
Date of REC Opinion
5 May 2015
REC opinion
Further Information Favourable Opinion