Nurses would prefer less aggressive treatments for themselves if they were dying, compared to what they would be willing to administer their patients and even their own parents, a new study shows.

In an international survey of 1,089 nurses between June 2011 and July 2012, researchers found that nurses around the world prefer less aggressive end-of-life (EOL) treatment options, but would use extreme modes of treatment for their own patients and parents.

"Globally nurses chose different EOL treatments for themselves than they do for their patients," said Joyce Fizpatrick, Ph.D., RN, FAAN, lead investigator on the study from the Frances Payne Bolton School of Nursing at Case Western Reserve University. "The question is if they chose this as best personal choice, why isn't it the one for the patients?"

The study involved surveying nurses from across cultures and from five countries: Hong Kong, Ireland, Israel, Italy, and the United States.

The nurses were given three hypothetical scenarios of a dying patient and given the chance to explain what EOL intervention they would use for the patient, their parents, and themselves.

One scenario involved an 84-year-old patient with Alzheimer's in a nursing home who suffered gastrointestinal bleeding and was in shock and at risk of dying. They were given four treatment options to choose from: palliative, limited, surgical, or intensive care.

A second scenario asked the nurses to treat them as if the patient was their father, while the third scenario asked them to imagine themselves as the older patient.

In addition, the nurses were asked about their preference for CPR or feeding tubes. In this case, most nurses prefered CPR while their patients and parents would be given the tube feeding intervention.

"Making these decisions is complicated when the patient is unable to speak due to cognitive or medical problems," Fitzpatrick said, so difficult and emotional choices are made by families and clinicians.

The findings explained that nurses were influenced by their duty of care, sometimes uncertainty of the outcomes, the patient's age, not knowing their parent's wishes, and personal experiences with family and having no contact with them.

Currently, end-of-life issues are a global topic of debate. For years the option was left to the doctor, more patients now have been given a choice through advance decisions and their proxies who help them decide their intervention options. While the United Kingdom, Australia, Canada, and United States, among other nations, have followed pursuit in patient choice, countries including Hong Kong, Ireland, and Italy have yet to put these efforts in place.

The study was published in the April issue of International Nursing Review.


Coffey A, McCarthy G, Weathers E, et al. Nurses' preferred end-of-life treatment choices in five countries. [published first online 8 April 2013]. Int Nurs Rev. 2013; doi:10.1111/inr.12024. Accessed May 14, 2013.