The burden of the conversation
The healthcare professionals mentioned that the conversations can be complicated. It can be complicated because sometimes there is adiscrepancy or dissension of ideas between the doctor and the patient. “In some situations, I have the idea that what you do is never actually good. Because sometimes, when a patient dies, that is not what the family wanted. But also, when someone survives the ICU but with a low quality of life, it is also not what the family wanted” [Interview 7]. The healthcare professionals also indicated that there are situations where there is a disagreement with the patient about the treatment limitation. In some cases this leads to a certaincommotion . “Yes, I have also been accused of not wanting to treat someone anymore or something… helping someone more towards death…” [Interview 5]. Cultural difference is also a subject that has been mentioned by the healthcare professionals as being difficult sometimes. Some families, because of their religious beliefs, do not want to give up treatment. Instead they want to do everything that is possible to prevent the patient from dying even though in some cases this is medically irresponsible in the professional’s eyes. This can lead to differences in opinion and unpleasant situations.“There are also transcultural problems, that we as doctors think that it is better if the patient doesn’t go to the intensive care, but the family is pushing us to do so, regardless of the situation of the patient. These are difficult situations…” [Interview 7].Healthcare professionals also indicated that the conversations will be normalized for patients as long as they are consequently performed.