• Shelly Orr, Nikolaos Efstathiou, Marianne Baernholdt, and Brandi Vanderspank-Wright.
• Research Operations Program Director (S.O.), Virginia Commonwealth University Health System, Richmond, Virginia, USA; Lecturer (N.E.), University of Birmingham, Birmingham, England, UK; Associate Dean for Global Initiatives and Professor (M.B.), University of North Carolina, Chapel Hill, North Carolina, USA; Associate Professor (B.V.W), University of Ottawa, Ottawa, Ontario, Canada. Electronic address: michelle.orr@vcuhealth.org.
• J Pain Symptom Manage. 2022 May 1; 63 (5): e521-e528.

ContextAside from spontaneous death, a majority of ICU deaths occur after a decision to either withhold or withdraw life-sustaining measures, including withdrawal of ventilatory support. While terminal weaning or terminal extubation are both used, the lack of evidence on the superiority of one method over the other can create challenges for ICU clinicians. There is a need to explore clinicians' experiences related to terminal weaning/extubation to understand their decision-making processes as well as the context and mechanisms that guide this process.ObjectivesThis study aimed to explore ICU clinicians'experiences of Terminal Weaning of Mechanical Ventilation (TWMV) in order to better understand the process, and clinicians' feelings about the process.MethodsThis study used an exploratory descriptive qualitative design. Data were collected via semi-structured, face-to-face interviews with 20 ICU clinicians. An inductive, data driven thematic analysis approach was used for data analysis.ResultsAnalysis of the data resulted in four themes: Fine-tuning the Process of TWMV; Focusing on the Family; Ensuring Patient-Centered Care; and Impact on Health care Clinicians and Support Needs.ConclusionThe identified themes provide insight into the complexity of the withdrawal of mechanical ventilation within the context of end-of-life care in the ICU. The themes highlight the need for clear communication of a TWMV plan between clinicians to avoid conflict during the process, ensuring medication is in place for potential distressing symptoms, incorporating patient and family wishes in planning, supporting the family during the process, and training and support for clinicians.Copyright © 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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