Experiences of Families with End-of-Life Extubation Decision-Making within the Palliative Care ward, Karunruk Palliative Care Center, Srinagarind Hospital: A Qualitative Study

Abstract

Withdrawal of mechanical ventilation in end-of-life patients is a sensitive issue that profoundly impacts families psychologically. This qualitative research aimed to understand family members' experiences during the decision-making process and situations that occur within the palliative care unit at the Karunruk Palliative Care Center of Srinagarind Hospital. Using a phenomenological approach, 10 participants were purposively selected from family members who had been involved in extubatiion decision-making and received hospital-based palliative care. Data were collected through in-depth interviews until data saturation was reached and analyzed using Colaizzi's method. Trustworthiness was established according to Lincoln and Guba's criteria, encompassing credibility, transferability, dependability, and confirmability through data triangulation, member checking, and peer debriefing.

Results: The family’s journeys were divided into 5 critical phases: 1) Crisis phase: Despite feeling shocked and powerless to negotiate, families still placed hope in treatment; 2) Reality confrontation phase: Witnessing the patient's suffering through being dependent on numerous medical devices caused psychological distress; 3) Solution-seeking phase: Confidence in decision-making emerged when receiving transparent information and support from the healthcare team; 4) Letting go phase: Peacefulness during the patient's final breaths provided healing for those left behind; and 5) Adjustment phase: Quality care helped families navigate through grief with stability. Effective communication and genuine family involvement by the palliative care team are key factors in creating positive experiences and reducing psychological trauma following loss.